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When a simple hand movement, such as making a fist or moving the thumb, becomes painful, it could be from daily overuse. 

"One of the most common is something called de Quervain's tenosynovitis," says Dr. Kakar.

He says it's primarily a tendon problem. 

"If you think of the wrist, basically what we have here is that we have the tendons, which move your thumb. And they are covered by this band, and this is natural. We all have this, but in certain patients, they can have inflammation in this area," says Dr. Kakar.

When the tendons underneath this band become inflamed, they can cause intense pain.

"Now, luckily, the treatment for this is relatively straightforward."

Hand therapy and wearing a splint may help. 

"Sometimes we need to do a corticosteroid injection to decrease inflammation, and most of the times, it gets better. But sometimes we need to do surgery," says Dr. Kakar.

It's an outpatient procedure that involves opening the sheath surrounding the tendon to release pressure, and allow the tendons to glide more freely and pain-free. 

Related posts:

• Mayo Clinic Minute: Avoiding overuse wrist injuries
• Mayo Clinic Minute: Relief for achy wrists
• Mayo Clinic Minute: Why tennis is great for the heart and mind but rough on the wrist

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When winter brings ice and snow, slipping, sliding and falling become a problem.

"And immediately, if you think when you fall, you're going to put your wrist out. And what will happen is that will brace your fall, and all your body weight goes through there," Dr. Kakar says.

Dr. Kakar always sees an increase in wrist injuries immediately after winter storms, especially among older people whose bones may become weak over time because of conditions like osteoporosis.

In most cases, Dr. Kakar says four to six weeks in a cast to let the bone heal is the best treatment, assuming it's lined up properly, but sometimes surgery is necessary.

But avoiding a wrist injury when you fall on ice is difficult.

"I think when we fall, it's a split-second decision on how we're going to fall," Dr. Kakar says. "And the problem is if you fall onto your wrist, there's a high chance of a wrist fracture. If you fall down, for example, on your hip, then there's a hip fracture."

Dr. Kakar says if you have to walk in snow or on ice, it's best to slow down and have something or someone to hold onto in case you start to fall.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.

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ROCHESTER, Minn. — For joints to work well, they need cartilage, a slippery tissue that covers the ends of bones, acts like a shock absorber, and helps joints move smoothly. Joaquin Sanchez-Sotelo, M.D., Ph.D., a Mayo Clinic orthopedic surgeon, says many people lose cartilage as they age, but it does not mean that joint replacement is inevitable. Here are some tips for keeping joints healthy.

Cartilage degenerates for various reasons, Dr. Sanchez-Sotelo says. People may be born with abnormally shaped bones or a tendency toward weaker cartilage. Obesity, overuse or injuries from accidents also can damage joints and cartilage.

"When cartilage degenerates, the body forms bone spurs," Dr. Sanchez-Sotelo says. "This is a reaction to the main underlying problem, cartilage degeneration. Bone spurs can hit each other and become painful. Many patients get obsessed with bone spurs, but just taking them out won’t cure the problem, except in very rare circumstances."

Loss of articular cartilage is the essence of what is called osteoarthritis, a common joint disorder. Dr. Sanchez-Sotelo says most of his osteoarthritis patients are in their 60s when they go to see a health care professional with symptoms — achy and painful joints, stiffness, and loss of movement — that developed over time.

Dr. Sanchez-Sotelo says you can take steps when you are younger to protect your joints as you age. Having strong muscles around the joints can help take the load off the joints. However, people who exercise at high levels in sports, like football and bodybuilding, have higher risks of developing arthritis.

"You have to exercise within reason," Dr. Sanchez-Sotelo says. "Find that point where your muscles are healthy, flexible, strong and will protect the joints, but don’t overdo it."

Maintaining a healthy weight is important, as obesity is hard on the joints. Glucosamine and chondroitin are popular supplements for joint pain, but lack convincing evidence that they work, Dr. Sanchez-Sotelo says.

He offers these suggestions for managing arthritic pain:

• Modify your activities. If you have an arthritic hip or knee, instead of running — which results in the pounding of the joints — maybe you can try bicycling.

• Take the load off the joints with gait aids. Using a cane can help lighten the load on your hip, knee and ankle joints, and decrease the pain. A knee brace — worn outside the clothes — shifts the load to the healthier side of the knee joint.

• If the pain persists, you may want to consider over-the-counter medications, like acetaminophen and ibuprofen. However, be aware of the side effects, such as ulcers, kidney or heart issues. In general, narcotics should not be used for osteoarthritis.

• If the pain continues, you also may consider injections with medications, such as cortisone or toradol, which, when injected into the joint, can help relieve pain. Again, these medications have side effects, so be sure to speak with your health care professional.

• Hyaluronic acid, which also is injected, uses components similar to those of the joint lubricating fluid to try to replenish it. It has been more successful with the knee joint than hip and shoulder joints.

• Some injections, marketed as regenerative medicine, include stem cells and platelet-rich plasma. At this point, many consider their use as experimental since there is no firm evidence about their efficacy.

"In the past, older people just accepted joint pain," Dr. Sanchez-Sotelo says. "Now people are living longer and want to remain active as they age. We are not all destined for joint replacement. There are some people in their 80s and 90s who have great joints."

To interview Dr. Sanchez-Sotelo, please contact Rhoda Madson, Mayo Clinic Communications, newsbureau@mayo.edu.

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About Mayo Clinic   
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.  

Media contact:

• Rhoda Madson, Mayo Clinic Communications, newsbureau@mayo.edu

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ROCHESTER, Minn. — July is Sarcoma Awareness Month, bringing attention to a group of cancers that begin in the bones or soft tissues of the body. There are more than 70 types of sarcoma, including bone cancer. Treatments for bone cancer include surgery, chemotherapy, radiation, or proton beam therapy that targets the cancer.

Proton beam therapy is a type of radiation therapy that is more precise than traditional X-ray treatment that delivers radiation to everything in its path. Proton beam therapy uses charged particles in an atom — protons — that release their energy within the tumor. Because proton beams can be much more finely controlled, specialists can use proton beam therapy to safely deliver higher doses of radiation to tumors. This is especially important for bone cancers.

"Bone tumors need much higher doses of radiation than a sarcoma that arises purely in the muscle, which we call a soft tissue sarcoma," says Safia Ahmed, M.D., a radiation oncologist at Mayo Clinic. "These high doses of radiation often exceed what the normal tissues around the area can tolerate. Proton therapy allows us to give this high dose of radiation while protecting the normal tissues."

Bone cancer is rare, accounting for just 0.2% of all cancers. Some types of bone cancer occur mainly in children, while others affect mostly adults. Common bone cancers include Ewing's sarcoma, osteosarcoma, chordoma and chondrosarcoma. The most common sites include the pelvis, spine and base of the skull.

Whether a patient with bone cancer is a candidate for proton beam therapy depends on several factors, Dr. Ahmed says. The care team considers the patient's overall treatment plan, age, location of the cancer, the tissue surrounding the cancer, and potential benefits and risks from a high dose of radiation.

Proton beam therapy has side effects. Some are acute, such as fatigue, changes in the skin and pain if the tumor swells and presses on nerves. Long-term side effects include permanent damage to nerves or nearby organs, bone fractures, or the possibility of developing another cancer.

Before getting proton beam therapy, patients go through a simulation, which is essentially a dress rehearsal of how the radiation will go. The purpose is to identify the proper treatment position for the therapy since the radiation is so focused and precise, Dr. Ahmed says. The team uses custom immobilization devices, getting CT scans and MRI images as they develop the patient's radiation plan. Patients also received a small blue tattoo — about the size of a small mole— on the area of the tumor to help with positioning.

"We are very meticulous about it because we want to come up with the best radiation plan that is safe and effective for patients," Dr. Ahmed says. "Once that process is done and the patient is ready to start, they come in daily for treatments. It's all about precision."

Patients typically undergo proton beam therapy five days per week for several weeks, with several more weeks of recovery. The care team continues to monitor the patients who receive regular scans.

"Unfortunately, there's always concern about the cancer returning," Dr. Ahmed says. "But we've made so much progress with all of our treatments. Our survival outcomes and efficacy have improved and continue to improve."

For more information on how proton beam therapy for bone cancer spares surrounding tissue, follow the link to the Q&A podcast on the Mayo Clinic News Network.

Dr. Ahmed is available for media interviews. Please contact Rhoda Madson, Mayo Clinic Public Affairs at newsbureau@mayo.edu.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact: 

• Rhoda Madson, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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"Ulnar wrist pain is a small area from the pinky side of your hand. And it's from this little knobbly bone called the ulnar to this area near the wrist," says Dr. Sanj Kakar, a Mayo Clinic hand and wrist surgeon. "It's very, very common."

Ulnar wrist pain can occur after a fall onto an outstretched hand. But it also happens in people who play stickhandling sports, like tennis or hockey, and certain occupations that require lifting or using a repetitive motion in the wrist. 

"And then it manifests in, for example, when they're turning a door, opening a jar, when they're pouring a glass of water — that twisting motion," says Dr. Kakar.

Bones, cartilage, muscles, tendons and ligaments — all can be sources of ulnar wrist pain. Treatment varies.

"Sometimes it may be a simple sprain. And so we have a sort of acronym, RICE. We can rest it; we can ice; sometimes put on a sleeve — a compression sleeve — or a splint; and elevate," says Dr. Kakar. "But if it doesn't get better and if you have lingering pain, this is not something that you should sort of just work through it because there could be an underlying problem that needs to be diagnosed and treated effectively."

Your health care team, led by a hand and wrist specialist, may recommend hand therapy, a wrist brace, injections and possibly surgery.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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ROCHESTER, Minn. — Mayo Clinic Orthopedics and Sports Medicine will offer sports physicals for area students who are entering seventh to 12th grades and want to participate in school sports programs. The exams, which follow the protocol set by the Minnesota State High School League, are open to all athletes from Southeast Minnesota.

Exams will be available by appointment only on July 30 from 8 to 11 a.m. CDT. Exams will be performed at Mayo Clinic Orthopedics and Sports Medicine, which is on the fourth floor of the Dan Abraham Healthy Living Center, 565 First St. SW, at Mayo Clinic in Rochester.

The sports physical costs $20 per student, which is payable at the time of the appointment by cash or check. Athletes should first request their sports physical on the Mayo Clinic Orthopedics and Sports Medicine website. After submitting the request, the participant will receive a phone call within two to three business days to schedule the appointment.

Before the exam, participants should complete the 2022–2023 Sports Qualifying Physical Examination Medical Eligibility Form. This form also is available at high school athletic offices or school websites, or on the Minnesota State High School League website. Participants should bring the completed form to the exam.

A parent or guardian must accompany a student under 18 to the exam. Participants and those accompanying them must wear a mask at the appointment and follow all directions from door screening staff. This may include mask checks and visitor protocols.

Athletes should dress comfortably for the exam. If athletes wear glasses or contact lenses, they should bring them.

The sports physical does not replace care or treatment from a primary care provider. If athletes have underlying medical conditions, they should see their primary care provider.

Optional baseline concussion testing will be offered for an additional $20 fee after completing the physical exam.

For information, contact Jolene Baker, medical administrative assistant, at Mayo Clinic Orthopedics and Sports Medicine at 507-266-1853.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Rhoda Madson, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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ROCHESTER, Minn. — A pain management regimen without opioids offered the same pain relief as common prescription opioids, according to two recent studies of common sports surgeries.

Opioids can help people manage pain, but they can be addictive. Nationwide, opioid prescriptions rose from 76 million in 1990 to a peak of 255 million in 2012. Between 1990 and 2017, deaths related to opioids increased sixfold.

The challenge for surgeons is to minimize opioid use while optimizing patients' pain control after surgery, says Kelechi Okoroha, M.D., a Mayo Clinic orthopedic surgeon and sports medicine specialist. Dr. Okoroha is the senior author of both studies.

Orthopedic and spine conditions account for about 3 in 10 opioid prescriptions, so surgeons can significantly decrease opioid-related deaths by limiting opioid prescriptions, Dr. Okoroha says.

Researchers created an approach to managing pain that eliminated opioids after common sports surgeries. In the first study, participants had undergone knee surgery to reconstruct their ACL. In the second study, participants had undergone surgery to repair their rotator cuff. All received a nerve block before surgery.

In each study, one group of participants received a standard opioid regimen to manage pain. The other group took part in a pain management approach without opioids. The nonopioid regimen included pain relievers, nonsteroid anti-inflammatory drugs and muscle relaxants.

Both studies found that the nonopioid regimen provided at least the same if not more pain control and patient satisfaction, compared with the standard opioid regimen.

In both studies, the most common side effects were drowsiness, dizziness and gastrointestinal symptoms. In the rotator cuff study, participants who received the nonopioid regimen reported slightly lesser side effects than those who received the opioid regimen.

Dr. Okoroha says one way Mayo Clinic is working to limit opioids is offering patients alternatives to traditional pain management.

"I think this is really game-changing research," Dr. Okoroha says. "We've found that it is effective in common sports surgeries. So our plan is to implement it in other surgeries and hopefully decrease the opioid burden worldwide."

Related post: Mayo Clinic Minute: Limiting opioids for postoperative pain management

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic's Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center. 

Media contact:

• Rhoda Madson, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Expert Alert: Managing pain after knee, shoulder surgeries without opioids appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. ―Michael J. Stuart, M.D., a Mayo Clinic orthopedic surgeon, will be the team physician for the U.S. men's ice hockey team at the Winter Olympics in Beijing. The games will be held Feb. 3–20.

Dr. Stuart will oversee the medical care for all players and staff of Team USA. Dr. Stuart will work with USA Hockey athletic trainers, and attend practices, team meetings, doping control testing and games, to ensure the team stays healthy and ready for competition amid the COVID-19 pandemic. He will also work in the medical clinic of the United States Olympic and Paralympic Committee to provide care to other Olympic athletes, as needed.

"The health and safety of players and staff are always paramount, but even more so during the pandemic," Dr. Stuart says. "We're following all the COVID-19 precautions and requirements and are looking forward to getting on the ice."

The U.S. Olympic men's ice hockey team opens play Feb. 10 against host China in the first preliminary round game.

"It's obviously an honor to represent our country. And it's a special opportunity for me to be part of a team, We really do work very closely together. We help each other out. And so I interface on a daily basis, not only with the athletic trainers, but also with our equipment managers, our coaches and, of course, our players, as well as the entire USOPC medical team," says Dr. Stuart.

Watch: Dr. Michael Stuart honored to be team physician for U.S. Men's Hockey.

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Dr. Stuart's roots in the hockey and sports community run deep. He is the chief medical and safety officer for USA Hockey, member of the International Ice Hockey Federation's medical committee and president of the Rochester Mustangs sled hockey team. He is also former co-director of Mayo Clinic Orthopedics and Sports Medicine in Rochester, Minnesota.

This is Dr. Stuart's fourth turn as team physician of the U.S. Olympic Games' men's ice hockey squad. Previously, he served at the 1994, 2010 and 2014 Olympic Games.

Dr. Stuart also can address other orthopedic and sports medicine topics, including:

• Ice hockey injuries.
• Arthroscopy.
• Knee ligament reconstruction.
• Partial knee replacement.
• Meniscus tears.
• Patellar dislocation.
• Concussions.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic's Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center. 

Media contact:

• Rhoda Madson, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Expert Alert: Mayo Clinic physician to lead US men’s ice hockey medical staff at Winter Olympics in Beijing appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Winter is a wonderful time of year, especially if you can avoid slipping, falling and getting hurt.

Sanjeev Kakar M.D., a Mayo Clinic orthopedic surgeon who specializes in injuries to the hand and wrist, treats his share of injuries during the winter.

Here are some of the common injuries Dr. Kakar sees and how he treats them:

Frostnip and frostbite

Frostbite happens when the skin and underlying tissues freeze. Mild frostbite ― the earliest stage of the condition ― is known as frostnip.

"It's a spectrum. With the milder forms, you can get some pain and some numbness of the fingertips, and the skin can change its color," Dr. Kakar says. "It can be red, white or blue. Blisters can also develop on your hands, and it can be a very serious injury."

Frostbite is more common than people think, Dr. Kakar says. He sees frostbite when the temperature is 5 degrees Fahrenheit with minimal windchill. If the windchill drops to 15 degrees below zero Fahrenheit, frostbite can set in within 30 minutes.

The fingers, toes, nose, ears, cheeks and chin are especially at risk. Exposed skin in cold, windy weather is most vulnerable, but frostbite can occur on skin covered by gloves and clothing.

You can treat frostnip at home with first-aid care, as the skin is not permanently damaged. Beyond that, seek medical attention because frostbite can permanently damage skin, muscle, bone and other tissue. Depending on the severity of the injury, treatments could include medications, wound care or surgery.

Wrist fractures

Dr. Kakar also sees a rise in wrist injuries immediately after winter storms, especially among older people whose bones may be fragile because of conditions like osteopenia or osteoporosis. However, he also sees snowboarders, skiers and ice skaters who have broken their wrists during their activities.

Treatments can include a splint, cast or surgery. In most cases, Dr. Kakar says four to six weeks in a cast to let the bone heal may be needed, assuming it's aligns properly. Sometimes surgery is needed. Surgeons then place plates, screws or pins to stabilize the broken bone so it can heal correctly.

Dr. Kakar says he sees many broken wrists during holiday merriment. People fall, don't realize they're hurt and wake up sore. It's best to get your injury checked out as soon as possible. If you must walk in snow or on ice, take it slow and have something or someone to hold onto in case you start to fall.

Thumb ulnar collateral ligament injuries

"Skier's thumb" happens when the skier falls — while the ski pole is planted — onto an outstretched hand or thumb, or the pole pulls against the hand and tears the ulnar collateral ligament of the thumb. The ligament can be partially torn or completely ruptured. Most of the time, X-rays are negative for fracture, though it's possible to have an avulsion, or chip fracture, Dr. Kakar says.

Symptoms of skier's thumb include tenderness, pain and swelling, as well as instability of the thumb knuckle, or metacarpophalangeal joint. If the patient's thumb is stable, Dr. Kakar can treat the injury with a splint or cast for four to six weeks. Surgery may be necessary with unstable joints, complete ruptures or fractures.

"It's an outpatient procedure. We repair the ligament back down to the bone," Dr. Kakar says. "After that, patients go to a hand therapist who can help get them back to their activities and out of a cast much quicker, as surgical techniques have advanced."

Besides skiing, thumb ulnar collateral ligament injuries can happen in a number of sports that require hand-held equipment, or hand or ball contact ― or, for example, if you fall off a bicycle and the thumb catches the handlebar. A chronic version ― called "gamekeeper's thumb" ― occurs when repeated motions gradually stretch and tear the ligament.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic's Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center. 

Media contact:

• Rhoda Madson, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Expert Alert: Don’t let common winter injuries take you down appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Patients and staff are the heart of Mayo Clinic. Their close collaboration, determination and innovation often make what might have seemed impossible possible. In this holiday season, Mayo Clinic offers deepest appreciation to patients and staff.   

"I would like to express my gratitude to patients, their caregivers and the entire Mayo Clinic staff," says Halena Gazelka, M.D., medical director for Public Affairs at Mayo Clinic. "Many of our patients have shared stories of fortitude, compassion and commitment to achieving the best possible outcomes. Stories like these inspire us every day."     

Here are some of the many stories patients have shared over the past year:

• Three-year-old takes on rare cancer with a little help from his friends
• Thanks to 3D printing, man’s grandchildren know he’s grandpa
• Kidney transplant gets chef back to the kitchen  
• Advanced care at home: A patient’s experience and beyond
• Unique neurologic symptoms lead to surprising cancer diagnosis
• Chain of transplants from coast to coast gives teacher gift of life
• Dancing through complex cancer, Crohn’s disease care during COVID
• A regenerative bridge to transplant
• Genetics connect family at the hip
• Defeating obesity on the road to transplant
• The beat goes on — thanks to deep brain stimulation
• A mother’s heart and an early arrival
• A father’s gift to his son  

"These examples of curing, connecting and transforming demonstrate the power of teamwork among patients, their loved ones and their care teams," Dr. Gazelka says. "Thank you, and please accept my my warmest wishes for a joyous holiday season."

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic's Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center.

Media contact:

• Sharon Theimer, Mayo Clinic Public Affairs, newsbureau@mayo.edu

For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place.  Anyone shown without a mask was photographed prior to COVID-19.

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