http://handcenter.org/idupform/predictomat.htm
Saturday, July 28, 2012
Monday, November 21, 2011
OCD STICK snow blower safety this winter
Recommendations for safe use of a jammed snow blower snow blowers include : (OCD STICK) off, clutch, delay, stick
1. If the snow blower jams, immediately turn it OFF
2. Disengage the CLUTCH
3.DELAY.. Wait 10 seconds after shutting of to allow Impeller Blades to stop rotating
4. Always use a STICK or broom handle to clear impacted snow. The stick most be strong enough to avoid breakage or eye injures can result from flying fragments
5. Never put your hand near chute or around blades
6. Keep all shields in place. Do not remove safety devices on machine
7. Keep hands and feet away from moving parts
8. Keep a clear head, concentrate and ...
Do not drink alcoholic beverages before using a snow blower
As physicians dedicated to the care of the Hand and Upper extremity we want to inform the public concerning the perils and pitfalls of improper snow blower use. Physicians, nurses, allied health professionals and therapists who deal with these injuries live in fear of the first heavy wet snow of the season. Invariably injuries are seen despite general knowledge that these injuries occur. These safety tips cannot guarantee against injury but hopefully if you are reading these or even better spreading these... it is one more step towards preventing these types of injuries.
Conditions that are associated with a higher incidence of injuries, hay wet snow exceeding 6 inches of accumulation and temperatures above 28 degrees Fahrenheit offer good opportunities to provide warning for the public. We need your help to reduce the incidence of these preventable injuries.
SNOWBLOWER SAFETY: OFF CLUTCH DELAY STICK
ABOUT US: THE HAND CENTER
The Hand Center
At The Hand Center of Western Massachusetts, we care for the hand, upper extremity, and shoulder, including fractures, tendonitis, lacerations, nerve compression, carpal tunnel, arthritis, and workers compensation injuries, just to name a few.
The Hand Center is devoted to the care of the Hand, Upper Extremity and Shoulder. Our staff wants to provide you with a high quality of care. We are committed to successfully returning you to your daily work and leisure activities.
We strive to work closely with our patients and their families, other medical professionals, employers and insurance carriers to provide you with needed care. We know that the path to recovery from minor to major injuries can be a difficult one. Our highly specialized physicians and caring staff are interested in your success.
The Hand Center is devoted to the care of the Hand, Upper Extremity and Shoulder. Our staff wants to provide you with a high quality of care. We are committed to successfully returning you to your daily work and leisure activities.
We strive to work closely with our patients and their families, other medical professionals, employers and insurance carriers to provide you with needed care. We know that the path to recovery from minor to major injuries can be a difficult one. Our highly specialized physicians and caring staff are interested in your success.
Our office is unique in Western New England where orthopedic surgeons and plastic surgeons often work in the field of Hand Surgery but ours is the only practice in the Pioneer Valley that is devoted exclusively to the Hand and Upper Extremity. In New England Orthopedic Surgeons and Plastic Surgeons are often in busy offices that may not have the attention to fine details of your Hand and Upper Extremity needs. At the Hand Center of Western Massachusetts we pride ourselves in this facet of your care. So whether you are having a new problem or have been all over the area and have seen other New England area Orthopedic or Plastic Surgeons seeking care for an upper extremity problem we are happy to consider seeing you in consultation.
Here at The Hand Center of Western Massachusetts our physicians provide the individual attention and care that you need. You will always be seen by one of our highly skilled Hand surgeons at every visit. Our staff and physicians often treat complex problems seen by other Orthopedic Surgeons in the New England area, and we feel that if you are coming to see one of us you should see a physician each and every time.
Here at The Hand Center of Western Massachusetts our physicians provide the individual attention and care that you need. You will always be seen by one of our highly skilled Hand surgeons at every visit. Our staff and physicians often treat complex problems seen by other Orthopedic Surgeons in the New England area, and we feel that if you are coming to see one of us you should see a physician each and every time.
Doctors Wint, Wintman, and Martin are fellowship trained hand surgeons. Doctors Wint and Wintman are trained in and Board Certified in Orthopaedic surgery with certificates of added qualifications in surgery of the hand. Dr. Martin is Board certified trained in plastic surgery, and has a certificate in hand surgery as well
Our physicians have surgical privileges at Baystate Medical Center, Pioneer Valley SurgiCenter, Mercy Medical Center, Mary Lane Hospital, Cooley Dickinson Hospital and Noble Hospital
WHAT to do after a hand injury and an ER visit?
WHAT SHOULD I DO IF I HAVE BEEN SEEN AT A HOSPITAL FOR A FINGER, HAND, WRIST or FOREARM INJURY?
Q. What should I do If I've been seen in a local emergency room for a hand, wrist, forearm or upper extremity fracture or injury?
A. It is important that day or night to follow the ER or ED instructions for post injury care. If you are told to elevate or ice or take a certain medication please do as you are instructed. Make sure you fill prescriptions that you may need. If you are not sure whether a medicine given to you by the Emergency Physician is correct call the hospital back and ask. In addition you should arrange for appropriate follow up care with a qualified physician.
Here are 6 important TIPS for delayed and urgent care of HAND AND WRIST FRACTURES that have been seen in a local Emergency Department ...in Western Massachusetts and Northern Connecticut
1.Contact your PCP. They can provide interim care or redirect you.
2. Call us. We like to accommodate potential patients. Unfortunately we cant always accommodate everyone who calls.
3. Call the ER back. Often they can advise you over the phone if you've been seen recently
4. Return to the ER where you were seen. Most ER's will be glad to see you again
5. Call a doctor you know of on your own. There is nothing wrong with seeking care on your own
6. Don't panic. Many hand and wrist injuries once stabilized in a local ER can be seen safely and effectively at a later date.
Most Hospital Emergency Departments will have given you a follow-up for a physician that they regularly work with, THERE ARE SOME TIMES THAT THEY DON'T HAVE A HAND SURGEON ON CALL OR ON STAFF. IN THOSE CASES YOU SHOULD SEEK OUT A HAND SURGERY GROUP IN THE AREA. WHILE THERE MAY NOT BE AN IMMEDIATE APPOINTMENT AVAILABLE RECORDS FROM YOUR ER VISIT CAN BE OBTAINED AND IN MANY CASES AN APPOINTMENT CAN BE GIVEN WITHIN THE PROPER TIME FRAME. IT IS IMPORTANT TO REMEMBER THAT WHILE THE ER MAY STRESS BEING SEEN IMMEDIATELY THAT MANY HAND AND WRIST CONDITIONS CAN BE TAKEN CARE OF URGENTLY BUT NOT EMERGENTLY ONCE PROPER ER EMERGENT CARE HAS BEEN GIVEN. However there are conditions that may warrant being seen right away and at times you may be advised to go back to the original ER if you cant be seen in an adequate time frame. Every situation is different. and this information is not to be construed as ultimate medical advice. for the purpose of treatment.
Fireworks Safety
Hand Surgeons Agree:
Leave Fireworks to the Professionals
The American Society for Surgery of the Hand (ASSH) has urged the public to leave fireworks in the hands of the professionals.According to the U.S. Consumer Product Safety Commission, 38% of all reported fireworks-related injuries from June 22-July 22, 2001, were to fingers, hands, and arms. These injuries included burns, lacerations, fractures, and traumatic amputation.
Of the finger, hand, and arm injuries, the majority of injuries were caused from accidents involving firecrackers, bottle rockets, and sparklers— the three firework-types most often used in a backyard environment. Accidents involving firecrackers, bottle rockets, and hand-held sparklers totaled 57% of all firework injuries (source: American Pyrotechnic Association).
One solution that has been offered by the ASSH to individuals is to attend public fireworks displays, which are monitored for safety by a local fire department, rather than setting off fireworks near or around the home.
The following precautions should be taken when attending a public fireworks display:
portions Copyright © American Society for Surgery of the Hand 2008.
Modified/adapted altered by www.handctr.com from www.assh.org
Of the finger, hand, and arm injuries, the majority of injuries were caused from accidents involving firecrackers, bottle rockets, and sparklers— the three firework-types most often used in a backyard environment. Accidents involving firecrackers, bottle rockets, and hand-held sparklers totaled 57% of all firework injuries (source: American Pyrotechnic Association).
One solution that has been offered by the ASSH to individuals is to attend public fireworks displays, which are monitored for safety by a local fire department, rather than setting off fireworks near or around the home.
The following precautions should be taken when attending a public fireworks display:
- Obey safety barriers and ushers.
- Stay back a minimum of 500 feet from the launching site.
- Resist the temptation to pick up firework debris when the display is over. The debris may still be hot, or in some cases, the debris might be “live” and could still explode.
- Never give children hand-held sparklers. Sparklers cause 10% of all firework injuries (source: American Pyrotechnics Association)—and were associated with the most injuries to children under 5 years of age. (source: U.S. Consumer Product Safety Commission)
www.nfpa.org
Their PSA features voices of victims whose lives have been tragically altered due to fireworks
portions Copyright © American Society for Surgery of the Hand 2008.
Modified/adapted altered by www.handctr.com from www.assh.org
GOUT (from medscape)
GOUT (from medscape)
- Gout has 2 clinical phases: (1) a first phase of intermittent acute attacks that spontaneously resolve during 7 to 10 days with asymptomatic periods between attacks, and (2) a second phase of chronic tophaceous gout involving polyarticular attacks with crystal deposition (tophi) in the soft tissues or joints.
- Risk factors include use of thiazide diuretics, cyclosporine, and low-dose aspirin (< 1 g/day); insulin resistance metabolic syndrome; renal insufficiency; hypertension; congestive heart failure; and organ transplantation.
- Increased dietary intake of purines, ethanol, soft drinks, and fructose also increase the risk for gout. Intake of coffee, dairy products, and vitamin C reduces the risk for gout.
- Triggers for gout attacks include alcohol intake, diuretic use, hospitalization, and surgery.
- The diagnostic standard is synovial fluid examination for negatively birefringent monosodium urate crystals under polarizing microscopy.
- Hyperuricemia may not be present in an acute attack and may not be helpful in diagnosis.
- The differential diagnosis of acute gout includes other crystal-induced arthritides, rheumatoid arthritis, and a septic joint.
- The main aim of treatment is rapid pain relief and prevention of disability.
- Options include the use of NSAIDs; colchicine; glucocorticoids; and, sometimes, corticotrophin.
- Adjunctive measures include applying ice and resting the affected joint.
- NSAIDs and colchicine are first-line treatments of acute gout.
- Colchicine, given at 1.2 mg at the start of an attack and repeated at 0.6 mg 1 hour later, is more effective than placebo for pain relief within 24 hours.
- Glucocorticoids and corticotrophins may be used, but the evidence for intramuscular injections is limited.
- A 5-day course of prednisolone has been shown to be equivalent to indomethacin and naproxen.
- 7 to 10 days of treatment of gout may be needed for symptom control.
- Lowering urate levels may prevent acute flares of gout and development of tophi.
- Urate-lowering therapy for hyperuricemia is recommended for those with at least 2 gout attacks per year or tophi, but such therapy should not be initiated during acute attacks.
- Urate-lowering therapy should be started 2 to 4 weeks after flare resolution, with a low initial dose increased for weeks to months.
- The dose should be adjusted to achieve a urate level below 6 mg/dL, which is associated with a reduced risk for acute attacks and tophi.
- Allopurinol, a xanthine oxidase inhibitor, is the most commonly prescribed agent to lower urate levels.
- Febuxostat is another xanthine oxidase inhibitor approved by the FDA in 2009. At daily doses of 80 mg and 120 mg, has been shown to be 2.5 to 3 times more likely to achieve urate levels less than 6 mg/dL at 1 year.
- Uricosuric drugs (probenecid, sulfinpyrazone, and benzbromarone) block renal tubular urate reabsorption.
- Uricase and pegloticase were FDA approved in 2010 for chronic gout refractory to conventional treatments.
- Lifestyle changes such as avoidance of alcohol and diet modification may not be sufficient to control attacks.
- Intake of vitamin C and dairy products have been shown to reduce urate levels.
- For patients starting allopurinol therapy, the use of colchicine at a dose of 0.6 mg twice daily for an average of 5.2 months has been shown to reduce the risk for gout attacks and severity of flares.
- The optimal duration of treatment of tophi is uncertain, and ongoing prophylaxis until resolution of tophi occurs may be necessary.
- The author concluded that patients suspected of having gout should have the diagnosis confirmed by synovial fluid examination, and acute treatment after multiple attacks should be followed by allopurinol for urate lowering, with colchicine prophylaxis to prevent recurrence of attacks.
WORK RELATED CARPAL TUNNEL IN MASSACHUSETTS
WORK RELATED CARPAL TUNNEL IN MASSACHUSETTS FACT SHEET
What is Carpal Tunnel Syndrome (CTS)?
Carpal Tunnel Syndrome (CTS) involves compression of the median nerve at the wrist. The finger tendons, blood vessels and median nerve extend from the forearm to the fingers through a small tunnel (surrounded by bone) in the wrist, named the carpal tunnel. If any of the tendons in the carpal tunnel become swollen, the median nerve is pinched resulting in pain, numbness and tingling of the first three fingers of the hand. If CTS is not treated in its early stages, it can result in permanent disability. It is estimated that close to 1 million people in the United States annually may develop CTS, requiring medical care and leaving them at least temporarily disabled.1
What Causes CTS?
CTS can be caused by chronic diseases such as rheumatoid arthritis, gout, and diabetes. It has also been linked with pregnancy and birth control use. Exposure to workplace factors can also cause CTS. It is estimated that approximately 50% of all medically diagnosed cases of CTS are work-related.2,3
Work-related risk factors for CTS include repetitive and forceful exertions of the hands and wrists, combinations of either force or repetitive work and awkward hand postures, and exposure to hand vibration.4 Acute trauma to the wrist can also cause CTS.
Is Work-Related CTS Preventable?
Work related CTS (WR-CTS) is preventable. Prevention practices to reduce the risk of developing CTS are varied. Examples are:
•Adjusting your workstation so that you are working in the proper posture;
•Reducing the number of times per hour or a day you use your fingers and hands;
•Reducing the number and weight of forceful exertions such as lifting or pinching objects.
•Using well maintained, correctly sized tools.
Other prevention strategies involve changing work organization. These include, for example, reducing the pace of work, and making certain you take frequent rest breaks throughout the day.
What is known about work-related CTS in Massachusetts?
Since 1992, the Massachusetts Department of Public Health (MDPH), funded by the National Institute of Occupational Safety and Health, has conducted surveillance of work-related CTS in order to identify industries, occupations and workplaces where prevention efforts are needed. The Occupational Health Surveillance Program (OHSP) at the Department uses two data sources to identify cases of work-related CTS: 1) workers' compensation claims filed in Massachusetts with an injury code for "CTS"; and 2) case reports of confirmed and suspected work-related CTS filed by physicians in accordance with Massachusetts regulations requiring physicians to report select work-related conditions to MDPH.
Key Surveillance Findings
•Between March 1992 and June 1997, 4,837 cases of work-related-CTS were reported to OSHP.
•The highest rates of work-related CTS were found among workers in manufacturing industries. However, the largest numbers of cases were employed in technical, sales and administrative support occupations. Fifteen percent of the cases employed in manufacturing were employed in administrative/sales jobs.
•Data entry keyers, general office clerks, secretaries and cashiers appear on the list of occupations with both high numbers of cases and high rates of work-related CTS.
•Grocery stores were the single industry with the highest number of cases; cashiers made up 40% of the cases. Hospitals (a service industry) has the second highest number of cases. Secretaries make up 15% of the cases in the hospital industry.
•Over 300 cases were less than 25 years old, raising significant concern about the long term impact of work-related CTS on health and employment options of young workers who are just beginning their careers.
•Many more women in Massachusetts are getting work-related CTS than men. A number of factors likely account for this finding. Women may be more likely to select or be selected into high risk jobs. Underlying biological differences between men and women and gender differences in reporting injuries and seeking medical care are also possible factors.
•Over 70% of cases identified through workers' compensation who were interviewed have had surgery for their CTS and almost 70% reported CTS in both hands.
•Approximately 50% of the workers who attributed their CTS to keyboard use reported having had surgery for CTS and 50% reported CTS in both hands
1 Tanaka S, Wild D, Seligaman P, Behrens V, Cameron L and Putz-Anderson V.(1994):The US prevalence of self-reported carpal tunnel syndrome: 1988 national health interview survey data. Am J of Public Health 84(11):1846-1848.
2 Ibid.
3 Cummings H, Maizlish N, Rudolph L, Dervin K, Ervin A (1989): Occupational disease surveillance: Carpal tunnel syndrome. Morbidity and Mortality Weekly Report 38: 485-489.
4 Bernard B (1997): "Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back." Cincinnati: Department of Health and Human Services, National Institute of Occupational Safety and Health
SOURCE
Carpal Tunnel Syndrome (CTS) involves compression of the median nerve at the wrist. The finger tendons, blood vessels and median nerve extend from the forearm to the fingers through a small tunnel (surrounded by bone) in the wrist, named the carpal tunnel. If any of the tendons in the carpal tunnel become swollen, the median nerve is pinched resulting in pain, numbness and tingling of the first three fingers of the hand. If CTS is not treated in its early stages, it can result in permanent disability. It is estimated that close to 1 million people in the United States annually may develop CTS, requiring medical care and leaving them at least temporarily disabled.1
What Causes CTS?
CTS can be caused by chronic diseases such as rheumatoid arthritis, gout, and diabetes. It has also been linked with pregnancy and birth control use. Exposure to workplace factors can also cause CTS. It is estimated that approximately 50% of all medically diagnosed cases of CTS are work-related.2,3
Work-related risk factors for CTS include repetitive and forceful exertions of the hands and wrists, combinations of either force or repetitive work and awkward hand postures, and exposure to hand vibration.4 Acute trauma to the wrist can also cause CTS.
Is Work-Related CTS Preventable?
Work related CTS (WR-CTS) is preventable. Prevention practices to reduce the risk of developing CTS are varied. Examples are:
•Adjusting your workstation so that you are working in the proper posture;
•Reducing the number of times per hour or a day you use your fingers and hands;
•Reducing the number and weight of forceful exertions such as lifting or pinching objects.
•Using well maintained, correctly sized tools.
Other prevention strategies involve changing work organization. These include, for example, reducing the pace of work, and making certain you take frequent rest breaks throughout the day.
What is known about work-related CTS in Massachusetts?
Since 1992, the Massachusetts Department of Public Health (MDPH), funded by the National Institute of Occupational Safety and Health, has conducted surveillance of work-related CTS in order to identify industries, occupations and workplaces where prevention efforts are needed. The Occupational Health Surveillance Program (OHSP) at the Department uses two data sources to identify cases of work-related CTS: 1) workers' compensation claims filed in Massachusetts with an injury code for "CTS"; and 2) case reports of confirmed and suspected work-related CTS filed by physicians in accordance with Massachusetts regulations requiring physicians to report select work-related conditions to MDPH.
Key Surveillance Findings
•Between March 1992 and June 1997, 4,837 cases of work-related-CTS were reported to OSHP.
•The highest rates of work-related CTS were found among workers in manufacturing industries. However, the largest numbers of cases were employed in technical, sales and administrative support occupations. Fifteen percent of the cases employed in manufacturing were employed in administrative/sales jobs.
•Data entry keyers, general office clerks, secretaries and cashiers appear on the list of occupations with both high numbers of cases and high rates of work-related CTS.
•Grocery stores were the single industry with the highest number of cases; cashiers made up 40% of the cases. Hospitals (a service industry) has the second highest number of cases. Secretaries make up 15% of the cases in the hospital industry.
•Over 300 cases were less than 25 years old, raising significant concern about the long term impact of work-related CTS on health and employment options of young workers who are just beginning their careers.
•Many more women in Massachusetts are getting work-related CTS than men. A number of factors likely account for this finding. Women may be more likely to select or be selected into high risk jobs. Underlying biological differences between men and women and gender differences in reporting injuries and seeking medical care are also possible factors.
•Over 70% of cases identified through workers' compensation who were interviewed have had surgery for their CTS and almost 70% reported CTS in both hands.
•Approximately 50% of the workers who attributed their CTS to keyboard use reported having had surgery for CTS and 50% reported CTS in both hands
1 Tanaka S, Wild D, Seligaman P, Behrens V, Cameron L and Putz-Anderson V.(1994):The US prevalence of self-reported carpal tunnel syndrome: 1988 national health interview survey data. Am J of Public Health 84(11):1846-1848.
2 Ibid.
3 Cummings H, Maizlish N, Rudolph L, Dervin K, Ervin A (1989): Occupational disease surveillance: Carpal tunnel syndrome. Morbidity and Mortality Weekly Report 38: 485-489.
4 Bernard B (1997): "Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back." Cincinnati: Department of Health and Human Services, National Institute of Occupational Safety and Health
SOURCE
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