Patient Questions

David Neuman is an Expert Contributor on FindaTopDoc. Here are some of their recent answers to patient questions.

Orthopedist
David Neuman

Hello and thanks for sharing your ankle issue with the FATD community. Allow me to give you thoughts, tips, and suggestions regarding this ankle problem. I am relieved to read that the problem was not due to a specific traumatic injury and that it has not been ongoing for more than a day. Therefore, it is most likely a fatigue-based or overuse type of onset of pain. If it is a symptomatic blood clot then the pain is usually in the inner thigh (tight and painful). I am not sure how much you exercise (or the type) and when the last time was that you exercised. My patients feel a bit more energy and less pain when they exercise. It can be something as simple and range of motion and gentle stretching exercises. Unfortunately, COVID-related bodily issues can be different for different people, so it is not easy to reliably related COVID to specific feelings of bodily pain. Severe anxiety may also play a factor in bodily pain manifestations. I recommend staying positive, getting rest, hydrating, and if your doctor permits it, taking anti-inflammatory medications with food for 2 days or so. Finally, exercise should be a part of the healing process. If the pains become worse over the next 10 days, then it may be best to consult a doctor. A more detailed history and a good exam would be a great step if the pains continue. I like this link: https://www.pop-doc.com/joint-preactive.html

It seems like this problem has arisen only 4 days before you wrote to us. There is no history of trauma or accident. With a history of smoking and drinking, I am curious as to how your lower back is functioning (pain, stiffness, etc.). When I read ‘numbness’ I think about a nerve problem (the small two-way electrical wires that run from the brain to the toes). The cramping, numbness, tingling, burning, and shooting pains are those associated with nerve problems. Other times it can be a circulation problem ( diminished blood flow to the feet and legs). If there is deep pain in the calves or the thighs, you may have a blood clot (and therefore should have an exam by your doctor). Other times, the pains will come and go as long as you continue to stretch the affected joints and keep the muscles strong. If the lower back begins to hurt or becomes more painful, then it may be more of a nerve issue. I would give it a few more days and if these feelings slowly resolve, then staying mobile, flexible, and strong is the best advice. If it slowly gets worse over the next 2-3 weeks then it is best to make an appointment with your primary care doctor, for a check-up. I hope this helps.

At the right time, strengthening the lower back is a great way to overcome sciatica. However, the strengthening aspects of sciatica relief should come only after the inflammation has subsided (with time, rest, anti-inflammatory medication (if your doctor is OK with you using them], and a heating pad). Once these pains have lessened, regaining full range of motion (of the lower back and hips) should be followed by muscle activation and flexibility exercises. I like this link: https://www.pop-doc.com/browse.cgi?category1=Lower%20Back Strengthening the core is a key to resolving sciatica, and if you can keep the muscles of the core (abdomen, lower back, buttocks, and hips) strong, you may be able to avoid a recurrence of this annoying condition (also depending on the activities you do and the accidents you sustain). I enjoy minimal lower back pain by keeping my core strong, flexible, and mobile. I have faith that you can as well. I hope this helps.

The sedimentation rate (ESR) is a general blood test to depict the level of inflammation in your body. This who have an auto-immune disease, poorly controlled diabetes, gastritis, GI pains, and healing muscle or joint injuries can have an increased ESR. Those with undiagnosed infections (UTI, URI, GI, excessive skin pimples, etc.) can also have an increased ESR. Therefore, ESR taken as the only blood test marker is not specific. A good history and a thorough physical examination are needed to get a better understanding of what may be going on in your body. I hope this helps.

Sometimes a broken wrist (fracture of the bones in the wrist) can also tear or stretch out the soft tissues that hold the wrist bones together (the ligaments). Bones generally heal, and if they were set in an acceptable fashion and alignment, they do not generally cause pain or loss of function. However, if the bones in the wrist are loose and moving around too much (‘popping out’, grinding on each other, giving way, etc.), then perhaps the ligaments are not functioning well. An MRI is usually done in a static (non-moving) position, as opposed to dynamic (or the wrist moving around to see how the bones move around each other). The readings are also open to interpretation. A grade 1 or 2 tear is very hard to determine based on an MRI and especially in the wrist since the bones are oddly-shaped and small. Clinically (how you are feeling and functioning), if 5 months have gone by and there are still feeling that something is not right in the wrist, it is recommended that you treat with a Board-certified hand surgeon, so they can thoroughly evaluate you and guide you to a better-functioning wrist. I hope this helps.

Thank you for sharing your shoulder stiffness question with the FATD community. I offer you my thoughts, tips and suggestions to this question. Chiropractors are very helpful in certain scenarios. However, some are better educated, more understanding, and more comprehensive than others. The first item to understand is whether or not this is in fact a shoulder issue or a neck issue with referred pain into the shoulder. A good examination is therefore recommended. Shoulder stiffness is quite common. If there was no big trauma or accident that brought the stiffness on, then it can be a transient stiffness secondary to sleep, overuse, or may be part of the normal aging process. However, it does not mean you need shots or surgery, but rather some guidance and action items. I like this link to help regain shoulder motion: https://www.pop-doc.com/browse.cgi?&action=browse_results&category1=Shoulder&category2=Motion I prefer a great massage by a massage therapist rather than a chiropractor, but once again it depends on whether or not the stiffness is due to a neck problem or a shoulder problem. With or without massage, doing the right exercise to get back your motion is the most important aspect to resolve the shoulder stiffness. This may be a slow and steady process, but every two weeks you should feel a bit better rather than a bit worse. I hope this helps. David T. Neuman, MD FAAOS Sports Medicine and Orthopedics 131 West 33rd St. Suite 12E New York, NY 10001 P: 212-813-3634 F: 212-857-9411 www.nysportscare.com Confidentiality Notice: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients named above. It may contain confidential and protected health information subject to privacy regulations such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is strictly prohibited. If you have received this communication in error, please notify me immediately by replying to this message and deleting it from your computer.

Hello and good day. Thanks for sharing your lower leg and knee pain question with the FATD community. Please allow me to offer my thoughts, tips, and suggestions regarding your issue. I am sorry to read about your knee and leg pain. From the limited history written, I am unsure if there was ever any trauma to the leg/knees or any developmental incident or issue. If not, then I am optimistic that an evaluation and treatment from a rehab specialist could help understand your muscle, bone, and joint architecture a bit more and give you guidance towards a pain-free existence. I hope this helps.

Hello and good day. Thanks for sharing your backbone pain with the FATD community. Please allow me to offer my thoughts, tips, and suggestions regarding your issue. I am sorry to read about your backbone pain. At least it has not been ongoing for too long. From the limited history written, I am unsure if there was ever any trauma to the back, or any developmental incident or issue. In addition, I am not sure if you exercise (and if so, how often and what type) or the type of work you do. Finally, I am not sure if this is the upper, middle, or lower backbone since the backbones are made up of 33 vertebrae (individual bones stacked on each other). If there has been no accident or trauma to the back, then the most likely cause is fatigue failure (tired muscles) that has irritated some of the other structures in the back (ligaments, joints, and bones). I like to follow this link to help recover after the onset of pain. https://www.pop-doc.com/joint-preactive.html I am optimistic that if you follow these steps, you will feel better. However, if you feel like it is getting worse in the next 2-3 weeks, then your issue deserves an evaluation and treatment from a medical provider, to help give you guidance towards a pain-free existence. I hope this helps.

Hello and good day. Thanks for sharing your posture corrector question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure if there was ever any trauma to the back, or any developmental incident or issue. In addition, I am not sure what type of device you are referring to. I am a huge believer in understanding your own body and then doing the right things to keep it functioning well for a long time. A posture corrector is not helping you overcome the root cause of your problem, and may make you dependent on it. The root cause is either developmental, environmental (your work/school and what you do during the day), or physical (a lack of muscle strength, endurance and conditioning tied into a suboptimal fascia system). Becoming flexible, strong and conditioned is the best way to overcome a postural problem. Finding a good practice that helps with this, and then making a routine to preserve good posture in your life, will give you a pain-free existence (in that area of concern, your posture) for a long time. I am optimistic that if you follow these suggestions, you will feel better and not be dependent on a brace. However, if you feel like you need a good exam and guidance from a professional, I encourage you to consult with a medical provider (like a rehab doctor/physiatrist). I hope this helps.

Hello and good day. Thanks for sharing your knee brace question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure if there was ever any trauma to the knee, or any developmental incident or issue. In addition, I am not sure what type of device you are referring to. I am a huge believer in understanding your own body and then doing the right things to keep it functioning well for a long time. A knee brace is not helping you overcome the root cause of your problem, and may make you dependent on it. The root cause is either developmental, environmental (your work/school and what you do during the day), or physical (a lack of muscle strength, endurance and conditioning tied into a suboptimal fascia system). Becoming flexible, strong and conditioned is the best way to overcome a knee problem. Wearing a knee brace has been shown to make people stiff (their leg) and weak (the muscles around the brace cannot work to their fullest potential). Wearing it at night will not help you very much, and may make it uncomfortable to turn while sleeping. Finding a good practice that helps with motion, strength and conditioning of the muscles around the knee and core, and then making a routine to preserve good bodily health in your life, will give you a pain-free existence (in that area of concern, your knee) for a long time. I am optimistic that if you follow these suggestions, you will feel better and not be dependent on a brace. However, if you feel like you need a good exam and guidance from a professional, I encourage you to consult with a medical provider (like a rehab doctor/physiatrist). I hope this helps.

Hello and good day. Thanks for sharing your ‘bad posture’ question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure if there was ever any trauma to the upper back, or any developmental incident or issue. I am a huge believer in understanding your own body and then doing the right things to keep it functioning well for a long time. The root cause of bad posture is either developmental, environmental (your work/school and what you do during the day), or physical (a lack of muscle strength, endurance and conditioning tied into a suboptimal fascia system). Becoming flexible, strong and conditioned is the best way to overcome a postural problem. Finding a good practice that helps with this, and then making a routine to preserve good posture in your life, will give you a pain-free existence (in that area of concern, your posture) for a long time. Depending on how bad it is, it may take 6-12 weeks, but that depends on how informed and motivated you are, and how desirous you are to make your posture better. I am optimistic that if you follow these suggestions, you will feel better and not be continually suffering from bad posture. However, if you feel like you need a good exam and guidance from a professional, I encourage you to consult with a medical provider (like a rehab doctor/physiatrist). I hope this helps.

Hello and good day. Thanks for sharing your hand surgery question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure of the type of surgery you are having. Most of the time, hand surgery can be done without general (a machine does the breathing for you during the surgery) anesthesia. However, the more pain you have, the more likely you move your hand, and the higher chance of increased bleeding and potentially complications since the doctor cannot achieve these fine maneuvers he/she needs to get the job done effectively and efficiently. Usually, some sort of anesthesia (to lessen the feeling of anxiety) and analgesia (to lessen the feeling of pain) are used for hand surgery. Sedation can be achieved in a pretty precise manner through medications delivered through the veins, and sometimes through breathing. If you are treating with a doctor experienced in hand surgery, and he/she has a team of good anesthesia doctors in a reputable facility, your surgery and the pain/anxiety you have during it should be minimal. However, everyone is different and if you have a low tolerance for pain and high anxiety, your experience with hand surgery may be different than for others. I hope this helps.

Hello and good day. Thanks for sharing your ‘ankle popping’ question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure what type of ankle issue you had that necessitated a cast. Also, I am not sure if you had ever hurt your ankle before. Nonetheless, the number one reason for a new onset of pain in an already-injured ankle is that it was not fully or completely rehabilitated prior to too much activity or sports. I hope you had a chance to get all your motion back and to strengthen the muscles around your ankle. Popping can be from the release of gas from the joint (not an issue at all). However, painful popping could be a sign of tearing of scar tissue or other tissues (like tendons or ligaments). The pins and needles you describe are either from the small nerves or blood vessels around the ankle. If you were in a cast for a long time, using the ankle again without the cast can cause popping and the feeling of pins and needles, as the body gets used to using the ankle again. I hope your pains and pins/needles feelings are short-lived. I am optimistic that if you follow these suggestions, you will feel better and not have these ongoing feelings. However, if you feel like you need a good exam and guidance from a professional, I encourage you to consult with a medical provider (like a rehab doctor/physiatrist). I hope this helps.

Hello and good day. Thanks for sharing your ‘knee popping’ question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure if you ever had a trauma or injury to the knee. Popping can be from the release of gas from the joint (not an issue at all). However, painful popping could be a sign of tearing of scar tissue or other tissues (like tendons or ligaments), or the rubbing of soft tissues over the bones or other soft tissues. The root cause of knee popping is either developmental, environmental (your work/school and what you do during the day), or physical (a lack of muscle strength, endurance and conditioning tied into a suboptimal fascia system). Becoming flexible, strong and conditioned is the best way to overcome a knee popping problem. Finding a good practice that helps with this, and then making a routine to preserve good posture in your life, will give you a pain-free existence (in that area of concern, your posture) for a long time. I am optimistic that if you follow these suggestions, you will feel better and not have these ongoing feelings. However, if you feel like you need a good exam and guidance from a professional, I encourage you to consult with a medical provider (like a rehab doctor/physiatrist). I hope this helps.

Hello and good day. Thanks for sharing your ‘knee cartilage surgery’ question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. From the limited history written, I am unsure as to what type of cartilage surgery you are having. The word cartilage has a few meanings in the knee. And, the word ‘recovery’ is also open to interpretation. Generally, skin incisions heal within 5-7 days. However, if you believe that recovery means ‘when will I feel no pain’ or ‘when can I get back on the playing field and be at an optimal state’, then the answers are different. As you know, surgery is a fantastic treatment modality but is not a cure. Cartilage tissue does not regrow. Therefore, if the cartilage is damaged and needs to be removed, it does not regenerate. So, your recovery may occur but you may never be 100 percent, and may not be ‘recovered’ for the rest of your life. After surgery, I like to follow these steps: https://www.pop-doc.com/joint-preactive.html Getting the pain and swelling resolved is the first priority, followed by regaining full range of motion, flexibility, strength, and condition. I would not go back to my favorite sports until one leg is about equal to the other in all these parameters. Finally, sports-specific exercises need to be successfully completed prior to returning to competitive sports (if you even want to, depending on the expectations you have regarding your knee and its life of it). So, recovery can be five days, or 12 months, depending on the extent of your surgery and what you want to do with your operated knee. Becoming and preserving a flexible, strong and conditioned leg (and core) is the best way to overcome/prevent a recurrent knee cartilage problem. Finding a good practice that helps with this, and then making a routine to preserve good posture in your life, will give you a pain-free existence (in that area of concern, your posture) for a long time. I hope this helps.

Hello and good day. Thanks for sharing your scoliosis question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. Scoliosis surgery should be performed by an experienced spine specialist that does these types of surgery often. The construct they create and the fixation is strong and stable. Once the pain subsides, which is different for everyone, you should be able to get out of bed. The longer you are in bed, the more muscle strength and girth is lost. In addition, people in bed for too long get compromised blood circulation and can develop blood clots in the legs. These are dangerous. So, by day one you should be in a chair, and then practice ambulating with assistance by day 1-2. Once the pain is subsiding, I believe in following steps to help you recover to an optimal point. I like to follow these steps: https://www.pop-doc.com/joint-preactive.html Becoming flexible, strong and conditioned is the best way to optimize a surgery like this. Finding a good practice that helps, and then making a routine to preserve good bodily health in your life, will give you a pain-free existence for a long time. I am optimistic that if you follow these suggestions, you will feel better and recover from surgery. I hope this helps.

Hello and good day. Thanks for sharing your scoliosis question with the FATD community. Please allow me to offer my thoughts, tips and suggestions regarding your question. Scoliosis surgery should be performed by an experienced spine specialist that does these types of surgery often. The construct they create and the fixation is strong and stable. As long as you are a strong person and had a medical clearance, there is low likelihood that you will lose your life as a direct result of scoliosis surgery. At times, if the spine deformity is bad, some of the nerves can get cut or stretched, which can lead to sensory changes and sometimes motor changes (difficulty walking or abnormal feelings), but rarely death. Once the pain subsides, which is different for everyone, you should be able to get out of bed. The longer you are in bed, the more muscle strength and girth is lost. In addition, people in bed for too long get compromised blood circulation and can develop blood clots in the legs. These are dangerous. So, by day one you should be in a chair, and then practice ambulating with assistance by day 1-2. Once the pain is subsiding, I believe in following steps to help you recover to an optimal point. I like to follow these steps: https://www.pop-doc.com/joint-preactive.html Becoming flexible, strong and conditioned is the best way to optimize a surgery like this. Finding a good practice that helps, and then making a routine to preserve good bodily health in your life, will give you a pain-free existence for a long time. I am optimistic that if you follow these suggestions, you will feel better and recover from surgery. I hope this helps. Stay optimistic and trust your surgeon.