Knee Arthroscopic Surgery – NEJM Needs to Get Their Story Straight

Posted on December 28, 2013 by admin

Quite some years ago, NEJM published an article saying flushing of the knee did not help knee pains, putting an end to that procedure. Now an article has been published by same journal says that partial arthroscopic meniscetomy does not work because flushing with sham surgery alone will decrease pain by 50% in two months. Sorry, NEJM, you can’t say both…

Continue reading →

Posted in Knee | 1 Comment

Teenage Chronic Headaches – 1/2 Might Be Chewing Gum

Posted on December 25, 2013 by admin

Isreali article found in teeenagers with chronic headaches, 19/30 cases resolved by quiting gum chewing

Continue reading →

Posted in Headaches | Leave a comment

“You earn money by suffering pain” – Sickening Commentary of Some Jobs

Posted on December 24, 2013 by admin

Interviewing immigrant poultry processing workers re carpal tunnel syndrome – comes up with simple belief – these workers knew that their work cause painful carpal tunnel but persevered to support their families. The repetitive cold working conditions fostered this condition. I have seen plently of cases where an injured worker will go back to a job that they know is harmful to their health just because they know nothing else and need to support themselves and family. Workman’s comp seems much more interested in getting them to return to their hostile work environment where their bosses demand them be 100% where I doubt the bosses are…

Continue reading →

Posted in Uncategorized | Leave a comment

Is Hip Arthritis a Bone Disease?

Posted on December 21, 2013 by admin

Serial MRI images were able to detect either broad band or localized signal changes in proximal femur during a period of hip pains. Subsequently, the hip pains may resolve but hip OA changes appeared on imaging. This  chronologs  the process – bone damage that resolves but cartilage damage follows…

Continue reading →

Posted in arthritis | Leave a comment

Is Anti-CCP -Any Good at Early Rheumatoid Arthritis Detection? – Not Really

Posted on December 20, 2013 by admin

Anti-cyclic citrullinated peptide (CCP) antibody is a blood test for Rheumatoid Arthritis. I have used it in hopes it would help with early detection but it seemed to always come back negative.. A recent study suggested it  has a 35% sensitivity. However, if it is positive it is near 100% specific.

Continue reading →

Posted in Rheumatic | Leave a comment

Can a CT Diagnose Pericarditis? – About as Good as Flipping a Coin…

Posted on December 18, 2013 by admin

Pulmonary embolism CT protocol for pericarditis has a  sensitivity of 54-59% and specificity of 91-96%.

A+cta Radiol. 2013 Dec 10. [Epub ahead of print]
Accuracy of computed tomography findings in acute pericarditis.
Hammer MM, Raptis CA, Javidan-Nejad C, Bhalla S.
http://www.ncbi.nlm.nih.gov/pubmed/24327762

  • CT looks for pericardial thickening or effusion
  • sensitivity is about 50-50 though specificity is high at 91-96%

Comment – don’t rely on CT

Posted in chest pain | Leave a comment

Trigeminal Neuralgia (TN) – How Good is the Gamma Knife?

Posted on December 17, 2013 by admin

Radiation “knifing” trigeminal nerve appears to be a safe and effective alternative in Trigeminal Neuralgia – though used more in people unable to tolerate microvascular decompression.

Continue reading →

Posted in Trigeminal Neuralgia | Leave a comment

Chest Pains After Implanted Pacemaker – Moving Leads Resolves It

Posted on December 17, 2013 by admin

4 cases of chest pains that developed after pacemaker lead implantation resolved by moving the leads in heart!

Continue reading →

Posted in chest pain | 5 Comments

Troubling Throat Pain – Lateral Thyrohyoid Ligament Syndrome – and There Really Must be a God…

Posted on December 16, 2013 by admin

Moderate pain over the upper lateral end of Thyroid cartilage in ligament between that point to hyoid bone  has recently been written up.  It is an obscure syndrome and I have not found anything on it before. The topic was written up in a journal my university no longer gets so I had to special order it – something I don’t usually do. The very morning I received the article, a patient comes in depressed because of troublesome pain in the throat… What are the odds?

Continue reading →

Posted in ENT | Leave a comment

De Quervain’s Tenosynovitis – Needs injection Plus Splinting

Posted on December 15, 2013 by admin

Having a Dequervain’s wrist tenosynovitis fail injection means surgery is a distinct possiblity; thumb spica increased success rates. Injection alone was successful in  69% without and 93% with splinting.

Continue reading →

Posted in wrist | Leave a comment

Reaching “Critical Mass” to Achieving Pain Control – Procedure Pearls

Posted on December 14, 2013 by admin

I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.

Continue reading →

Posted in arm, Back Pain, Botox, complex regional pain, Drugs, Fibromyalgia, Headaches, Injection, IV therapy, Leg Pains, Manual Med, myofascial pain, Neck, neuropathic, Pain Dystrophy, piriformis, post herpetic neuralgia, radiculitis, shoulder, Uncategorized | 9 Comments

Dry Eyes ?Cured by Peri- Lacrimal Injection of Platelet Rich Plasma

Posted on December 10, 2013 by admin

Dry eyes was significantly improved by repeated injections of  platelet rich plasma around lacrimal gland


Continue reading →

Posted in eyes | Leave a comment

How Much Relief Will Celecoxib Give in Frozen Shoulder?

Posted on December 10, 2013 by admin

A drop of 1.5/10 does not seem like much though they do say 71.4% got rid of night pain

Continue reading →

Posted in shoulder | Leave a comment

Failed Knee or Shoulder Arthroplasty? – Intra-articular Botox Injections Help

Posted on December 10, 2013 by admin

50% reduction of pain was reported in about 1/2 of post shoulder and knee arthroplasty pain cases with Botox injections. This was sustained by repeated injections.

Continue reading →

Posted in Botox, Injection, Knee, shoulder | Leave a comment

Migraines – More and Longer Attacks Might Mean Early Hardening of Arteries

Posted on December 10, 2013 by admin

Intimal carotid artery thickening was seen in migraine sufferers with more and longer attacks.

Continue reading →

Posted in Headaches | Leave a comment

Hip Osteoarthritis referral Patterns in Hip Dysplasia

Posted on December 9, 2013 by admin

Distribution of pain originating in the hip was 89 % to the groin, 38 % to the buttock, 33 %  to the anterior thigh, 29 %  to the knee, 27 %  to the greater trochanter, 17 %  to the low back, and 8 %  to the lower leg.  The 5% that did not have groin buttock, or trochanteric pains were more difficult to diagnose.

Continue reading →

Posted in Hip Pains | Leave a comment

Widespread Pains Common in Post Breast Cancer Patients

Posted on December 9, 2013 by admin

20.8% of post breast cancer sufferers were diagnosed with widespread pain and 10% with frank Fibromylgia.

Continue reading →

Posted in Fibromyalgia | Leave a comment

Fibromylagia (FM)- Does Magnesium Help?

Posted on December 9, 2013 by admin

Study finds erythrocyte magnesium levels are low in Fibromyalgia though adding it to amitriptyline had no additional benefit on pain. By self, pain reduction was not clinically significant.

Continue reading →

Posted in Fibromyalgia | Leave a comment

Bad Raynaud’s? – Botox It.

Posted on December 7, 2013 by admin

Raynaud’s phenomenon responds to Botulinum injection of neurovascular metacarpal bundles. Can get occasional temporary finger weakness (max 2-3 months)  though. Pain relief can last few months to more than 6 year

Continue reading →

Posted in Botox, hand | Leave a comment

Carpal Tunnel Syndrome and Vitamin B6

Posted on December 7, 2013 by admin

For years, it was suggested that people with carpal tunnel should take B6, but it fell out of favour ( in my mind) when excessive B6 was found to be neurotoxic. Now a recent study has confirmed use of B6 in carpal tunnel syndrome.

Continue reading →

Posted in Drugs, hand, neuropathic | 1 Comment

Flossing Saphenous Nerve For Saphenous Neuralgia

Posted on December 6, 2013 by admin

saphenous neuralgia is not uncommon – here is how to free it up (floss it)

Continue reading →

Posted in Leg Pains, neuropathic, Uncategorized | Leave a comment

Fibromyalgia Brain – Brain Loss in Elderly – but Growth in Younger

Posted on November 29, 2013 by admin

Brain loss with Fibromyalgia (FM) is well known in elderly. What is new is the finding of brain growth in younger subjects –  in Insula and basal ganglia – perhaps in attempt to control pain.

Continue reading →

Posted in Fibromyalgia | Leave a comment

Is Nortriptyline Any Good? – Maybe – but Maybe Only a Bit

Posted on November 27, 2013 by admin

Recently, nortriptyline has been touted as good anti-neuropathic drug but thoughts of its use have extended into use for chronic pain in general.  Well, it doesn’t work for back pain, sciatica or migraines so that might need reanalysis.

Continue reading →

Posted in Back Pain, Drugs, neuropathic | Leave a comment

What Have We Really Learnt About Opioid Overuse – Part is Over-Reliance on Pills to Treat Chronic Pain

Posted on November 18, 2013 by admin

Over-reliance on opioids is due to poor training of physicians in manual medicine and injection techniques. What techniques? – look at my blog and at the proliferation of chiropractors. Most of chronic pain has a major myofascial component that is simply ignored. Recently there was an article published on the major trend to opioid abuse in the USA.

Continue reading →

Posted in Drugs, Manual Med | Leave a comment

Weightbearing Pains with Wrist in Extension: – Self Treatment

Posted on November 18, 2013 by admin

If get pains in wrist in extension – especially with pressure – then a strap self-mobilization technique could help.

Continue reading →

Posted in wrist | 1 Comment