In the previous post, we discussed different types of surgeries which are used in patients with rheumatoid arthritis . This week I’d like to talk more about surgeries involving soft-tissue, specifically synovectomy, tendon repair, and carpal tunnel release.
What is a Synovectomy?
The synonium is a membrane surrounded a joint, usually only one or two cell layers thick, which produces synovial fluid to help lubricate the joint. In rheumatoid arthritis, the synovium becomes inflamed and may grow excessively, producing too much synovial fluid containing an enzyme that can eat away at the cartilage on the joint surface. Disease-modifying anti-rheumatic drugs (DMARDs) are used to control the abnormal growth of synovium.
If DMARDs do not work, a patient’s rheumatologist may suggest steroid injections into a joint or a needle aspiration of excess synovial fluid. If these strategies do not work, then the patient may be referred to an orth...
Diagnosis Carpal tunnel syndrome is most accurately diagnosed using a medical history, the patient's descriptions of symptoms, a physical examination, and electrodiagnostic tests that measure nerve conduction through the hand. Diagnosing CTS, however, is not straightforward. Only a small fraction of patients exhibit all three factors necessary for a clear diagnosis: Classic CTS symptoms Specific physical findings Abnormal electrodiagnostic test results Many people have abnormal electrodiagnostic test results without classic symptoms or any symptoms at all. Furthermore, about 15% of the population has symptoms that are consistent with CTS, but in most of these people, test results do not indicate the disorder. MRI, CT scans, and other imaging tests are not useful for diagnosing carpal tunnel syndrome. Symptom Description and Severity Many cases of CTS result from a medical problem that is worsened by repetitive stress factors at work. The patient should give the doctor a detailed history and de...
I just saw the following question:
I recently had carpal tunnel surgery on both hands at the beginning of June. It's now late July and my blood sugar levels are still in the 230s. I take Lantus twice a day. What can I do? I have a constant headache, jaw pain, teeth hurt; can this be making my level stay high?
Something doesn’t quite fit together here. As I understand it, you have had elevated blood glucose levels continuously since hand surgery that was done almost two months ago.
Surgery certainly can cause pain, and pain is a stressor that can raise blood sugar levels. Plus, after most surgical procedures, there’s decreased physical activity for a while, which also would contribute to high sugar levels. With that in mind, I think people with diabetes who are on insulin shots or pumps should be given explicit instructions on what target ranges to aim for post-operatively, and how to adjust their insulin to meet these targets.
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