We have received a number of requests concerning information about new medications for treatment of arthritis. Arthritis can come from many sources. The long term effect of arthritis is damage to the joint surface.

When the articular cartilage-which is the smooth gliding surface-is damaged, patients have pain and discomfort and inflammation when attempting activities.

There are many procedures available today to evaluate people with arthritis. Pain in the wrist and the joints of the hand can be evaluated by x-ray and MRI (Magnetic Resonance Imaging) studies, which allow us to view the bones of the joint and also the soft tissues.

Arthroscopy is another method for evaluating joints. This is done by placing a small telescope inside the joint to directly visualize injury or abnormalities. This can be done under a local anesthetic and give us a very good idea of whether arthritis is forming in the joint or other problems present.

With the arthroscope we can sometimes shave out the inflamed lining and/or clean out some of the debris inside the joint, giving relief.

There is a new group of medications that are basically the precursors or building block materials for cartilage in the joint. Glucosamine appears to be the most popular of these and may patients report good relief from their arthritic symptoms.

Studies are inconclusive to date as to the effectiveness of these medications, but we have seen many patients who respond to the glucosamine and have improvement. I have actually had the opportunity to perform arthroscopies on patients prior to and after taking glucosamine and have seen evidence of what appears to be cartilage regeneration and improvement with respect to pain and function.

Please feel free to call the Upper Extremity Institute for further information on glucosamine to decide if you or someone you know could benefit from this treatment.

We Can Help


If you or someone you care about is injured-call us. Remember, although we mainly treat upper extremity problems, we are here for you no matter what your injury. If it is an orthopedic problem of any kind, please call or e-mail us if you, a family member, a friend, or anyone else you know is injured or in pain. The earlier you call and let us know what’s going on, the better the chances that we can help you avoid surgery.

We get calls from patients all the time asking for our advice concerning injuries of knees, ankles, and backs. We strive to be a full-service institute, and whichever services we do not provide in-house, we certainly can steer you to a practitioner who would help you explore alternative as well as conventional treatments.

Many times patients are told to wait a few weeks or even months to see if their symptoms go away; this is a very dangerous scenario. Call us and let us know you have an injury. We will help you determine if you can wait or need to be seen right away.

Many are stuck in the system with respect to workers’ compensation injuries. The law now dictates that, in many cases, the worker must treat with the company doctor for 90 days. A lot can go wrong in 90 days!

Call us at 1-800-NERVE-55 during that time for personal advice on how to deal with the situation, or e-mail us at

Integrative (Alternative) Treatment for Repetitive Strain Injury, Carpal Tunnel and Thoracic Outlet Syndrome

The past fall I directed a meeting for the Greater Philadelphia Pain Society concerning thoracic outlet syndrome and upper extremity nerve pain. What came out of the meeting was the glaring fact that we cannot cure patients with nerve pain-and we can help them!

In essence, all the panel members agreed that, although we can help patients with meditation, surgery, therapy and alternative as well as standard healing techniques, we do not have the capacity to make these patients normal.
Nerve pain is a phenomenon which, at times, is due to direct compression of the nerve and sometimes scarring about the nerves. The combination of the two is often present.

More than Carpal Tunnel

Many patients are diagnosed as having “carpal tunnel problems” but really have a much more significant disease. A patient who comes to mind is Gene, whom I wrote about in my book, Light At The End Of The Carpal Tunnel.

Gene had been in a severe accident working as a director of traffic for a road crew. After being thrown in a ditch and having multiple injuries, he was treated and eventually discharged from a hospital. He continued to have significant problems with numbness in his hand.

He saw a number of doctors and was told he did not have carpal tunnel . By the time Gene got to me he was quite frustrated with his situation, and he told me ” I know I don’t have carpal tunnel because the numbness and tingling is in my 4th and 5th fingers and not my thumb, index or long finger.”

Obviously this was a man who had a very good idea of what was going on with him, and he did have a problem with his ulnar nerve at the elbow and also an injury to the nerves of the brachial plexus between the neck and the shoulder.

Subsequently we did end up operating on Gene’s elbow and he got excellent relief in that he didn’t have carpal tunnel surgery, but rather the appropriate surgery for his arm.

The Thoracic Outlet

Thoracic outlet syndrome involves the nerves between the neck and the shoulder. All of the nerves which go into the arm travel through the thoracic outlet and then become the major nerves of the arm-the median nerve of the carpal tunnel, the ulnar nerve or funny-bone nerve behind the elbow, and the radial nerve in the tennis elbow area going to the back of the arm.

The key to treatment of thoracic outlet syndrome Dr. Fried… continued from previous page
is an early diagnosis and appropriate treatment in
the way of behavior and activity modification, therapy, medications, and, as a last resort-surgery. Surgery for patients with thoracic outlet syndrome is highly dangerous with the possible complications of paralysis of the arm, collapse of the lung, paralysis of the voice box or face, and bleeding to death, to name a few.

Surgery should be undertaken only as a last resort and by someone who is well experienced in treating thoracic outlet problems and nerve injury. Treating the same nerves in the lower arm with splints, therapy, injections, and even surgery is often helpful in decreasing the amount of thoracic outlet pain and symptoms.

The Upper Extremity Institute has one of the most extensive programs of conservative treatment of thoracic outlet and nerve problems.

What Causes Thoracic Outlet Problems?

Thoracic outlet injuries come from many causes. They may result from an automobile accident or a so-called unresolved cervical strain and sprain or whiplash injury, tractioning or yanking injuries of the arm or neck, repetitive strain such as continuously pushing, pulling, keying, scanning, and heavy, regular lifting or aggressive lifting.

If you suppose that you or someone you know does have a thoracic outlet problem, we recommend that you obtain as much information about this as you can. We are available for consultation and even second opinions, and we participate in many insurances as an in- and out-of-network facility.

Remember that after 90 days with a work-related injury, you can choose whichever physician you like. And second opinions are often helpful even if you stay with your initial physician.

The key to treating any nerve injury or upper extremity pain problem is to understand your diagnosis fully. If you have a good understanding and knowledge of the situation, your physician’s and therapist’s treatment will have a better chance of success.

The Ergo Shoulder System and Abduction Pillow The First Immobilization Device designed to prevent Frozen Shoulder

Recovering from shoulder injury or surgery often takes a long time and usually requires a bulky device to keep the shoulder immobilized. The NEW and revolutionary Ergo Shoulder System and Abduction Pillowâ„¢ can treat these injuries and improve recovery results.

Dr. Scott Fried is the chief inventor of the Ergo Shoulder System and Abduction Pillowâ„¢. Due to Dr. Frieds own sports injury and his discontent with available immobilizers at the time, he developed the Ergo Shoulder System. This shoulder immobilizer is designed to provide easy movement and to alleviate the undue strain on the neck which can often cause pain and /or numbness.

Read more about ERGO. view photos and/or watch a video of the product >