Report on Hands from Doctors Demystify, April 2013
Contents:
 DD The Whys and Hows of Hand Surgery for OTs and PTs
Comments from March sessions: Registrants love hearing from their regional MDs
Upcoming cities and dates
 Journal Article Review
Effect of cortisone vs placebo injection w/wo therapy for tennis elbow
 Are there level 1 studies proving the benefit of parachutes when sky
diving?
DOCTORS DEMYSTIFY THE WHYS AND HOWS OF HAND SURGERY FOR OTs and PTs
Spend a Saturday getting inside of the heads of area hand surgeons. Understand hands from the
surgical perspective. Enhance your knowledge. Enlighten your patients. details
Format: After each of 6 talks (bone, skin, tendon, cartilage and ligaments, nerves, vessels)
registrants submit questions on notecards. Hand surgeon panelists discuss answers during 30
minute session following each talk.
Comments from March sessions of DD Whys and Hows:
Vancouver BC A great course, as usual!! I was happy with the somewhat longer talks per
on Mar 2, 2013 surgeon. The Q and A sessions were great! All the surgeons were very happy to
answer questions, and it was interesting to hear different points of view when
two or more of the surgeons discussed their different ways of managing a case.
Miami on
Great course and presenters. Room too cold and hot tea would have been nice.
March 16, 2013 Will definitely attend next year as well as other online classes.
Seattle
It's a pleasure to listen to surgeons and how they make decisions.
(Kirkland) on
Mar 16, 2013
Miami on
course content was good, MD's were interesting as usual, especially Dr.
March 16, 2013 Ouelette, only complaint was the room was freezing and ac was not adjusted
Miami on
good course content, MDs were great especially Dr. Oulette. Only complaint
March 16, 2013 was the room was freezing and ac could not be adjusted. glad I attended and
networked with fellow local chts
Miami on
Everything was good! Info I can bring back to the clinic.
March 16, 2013
Atlanta on
Thanks for utilizing DR. Dalton/Seiler's group in the Atlanta area. These 6 MD's
March 16, 2013 are some of the best in the South and they have years of experience in the
hand area. It's a treat listening to them.
New Orleans I always enjoy attending the DD courses.
on March 16,
2013
Seattle
I liked that there was plenty of time for open questions and discussion
(Kirkland) on following the lectures without getting behind schedule. In 20+ years taking
Mar 16, 2013 continuing education courses, this was the first time I experienced this. It was
New Orleans
on March 16,
2013
Seattle
(Kirkland) on
Mar 16, 2013
Seattle
(Kirkland) on
Mar 16, 2013
New Orleans
on March 16,
2013
Seattle
(Kirkland) on
Mar 16, 2013
Seattle
(Kirkland) on
Mar 16, 2013
Seattle
(Kirkland) on
Mar 16, 2013
fabulous!
I always enjoy attending the DD courses.
Loved the format, extremely helpful to hear MDs tell of specific cases and their
findings. Please have coffee.....we are in rainy dreary Seattle!!!
Break time specified coffee! Please have coffee!!!!
Thank you so much for combining great courses that are presented by the
experts while simultaneously providng easy access and very affordable costs. I
plan to go every year and have for past few years.
One of the best courses Iv'e been to in a while. The information was a nice
review and the QandA times was invaluable!
Excellent!
Great open question time...nice to have doctors avail for all questions.
Upcoming cities and dates Atlanta, Miami, New Orleans, and Seattle on March 16
Ann Arbor/Detroit
May 11 note revised date
Baltimore
April 27 Dr. Meals will participate
Boston
May 4
Chicago
April 13 THIS SATURDAY—NOT TOO LATE TO SIGN UP
Cleveland
October 26 date recently announced
Dallas
April 13 THIS SATURDAY—NOT TOO LATE TO SIGN UP
Denver
May 18 This is the correct date for Denver
Detroit/Ann Arbor
May 4
Grand Rapids
April 20
Houston
May 4
Kansas City
Sept 21
Minneapolis
April 27
New York City
May 18
Pittsburgh
May 4
Portland
May 18
Salt Lake City
April 27
San Diego
May 18
San Francisco
June 1
JOURNAL ARTICLE REVIEW Effect of cortisone vs placebo injection w/wo therapy
for tennis elbow
Last month I reviewed a carefully conducted study that showed that phonophoresis does not
deliver cortisone to human tendons. My link to the article did not work. Here is the link to that
article.
I intuitively expect that injection would deliver cortisone to tendon, but in the case of tennis
elbow, does it work? With or without therapy?
A rigorously designed and executed randomized, prospective, double blinded study regarding the
benefit of therapy and cortisone injection appeared in the February 6, 2013 issue of the Journal
of the American Medical Association. link
A group of investigators in Australia prospectively randomized 165 patients with lateral
epicondylitis into 4 groups: cortisone injection and therapy, cortisone injection without therapy,
placebo injection with therapy, placebo injection without therapy. Both subjects and investigators
were blinded regarding the type of injections given. (Of course, the presence or absence of
therapy could not be blinded.) The groups were well-matched with respect to sex, age, duration
of symptoms, and baseline pain, disability, and health-related quality of life scores. Follow-up was
excellent.
Therapy consisted of 8 weekly 30 minute sessions and regular home exercises, which were
monitored for compliance. The investigators followed the patients at regular intervals for a year.
At 4 weeks, placebo injection and therapy provided significantly more relief than placebo
injection alone, while cortisone injection and therapy did not provide any additional relief over
cortisone injection alone.
At 26 and 52 weeks, placebo injection patients were doing significantly better than those who
had received cortisone injection. At both time intervals, the presence or absence of therapy did
not make a difference.
So if somebody wanted to be better at 4 weeks, they should have no injection (more comfortable
than placebo injection!) and therapy. If they wanted to be better at 6 months or a year, they
should have no injection and no therapy!
Remember that tennis elbow is typically a life-style issue of people 40-60 years old. Those under
40 have resilient tissues that can withstand forceful repetitive activities. By the time people are
60, they have usually experienced multiple musculoskeletal symptoms that do resolve but with
progressively longer convalescent periods. As the 60 year olds have aged, they have adjusted
mentally to not going as far, fast, or frequent. For those between 40 and 60 who are distressed
that their ache is not rapidly resolving, maybe you want to remind them what the Commander
told Tom Cruise in Top Gun, “Your ego’s writing checks that your body can’t cash.”
EVIDENCE-BASED MEDICINE REGARDING THE EFFICACY of PARACHUTE USE
Until next month,
Roy A. Meals, MD
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