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Dr Post gives lecture on shoulder examination

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Dr James Post of Raleigh Hand Center gave a lecture on the physical exam and radiologic evaluation of patients with shoulder problems at WakeMed conference on 9/10/2018

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Why see a Hand Surgeon?

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The term “hand surgeon” can be misleading. Hand surgeons also treat patients with wrist, forearm, elbow, and often shoulder problems, as well as the hand. Additionally, hand surgeons don’t just do surgery. A hand surgeon is a specialized doctor who is trained in the non-surgical and surgical treatment of most hand and upper extremity conditions.

After completing a residency in general, plastic, or orthopaedic surgery, hand surgeons complete an additional year of fellowship training in the conditions unique to the hand and arm. The complete care of the hand involves specialized techniques in orthopaedic, plastic, neurologic, arthroscopic, and microvascular surgery — combining features from multiple surgical specialties. The hand is one of the most complicated parts of the body, and because of this, extra training is helpful to take care of hand conditions.

Over the last several decades, there has been progress in the treatment of hand and upper extremity conditions. New procedures have been invented and research has been published. Raleigh Hand Center physicians and therapists stay informed of the latest developments in hand care though weekly conferences and national meetings. National board certification is available in both orthopaedic surgery and hand surgery, and all Raleigh Hand Center physicians are board certified.

If you or a loved one has a hand or arm problem, consider consulting with a hand surgeon.

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Dr. Edwards III gives hand conference on nerve injuries

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Dr George Edwards III talked about Nerve Transfers of the Hand and Forearm on Monday August 27 at WakeMed UNC Orthopedic Hand Conference. Local area hand surgeons, therapists, Raleigh Radiology radiologist, and orthopedic residents were in attendance. This conference discussed the emerging techniques for treating patients with nerve injuries of the hand and arm.

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Elbow Pain Treatment in Raleigh NC

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One of the most common sources of elbow pain is tennis elbow. Tennis elbow, also called “lateral epicondylitis,” is a painful condition affecting many adult patients. Tennis elbow is caused by degeneration within the extensor carpi radialis brevis (ECRB) tendon on the outside of the elbow (lateral aspect). Despite the name, tennis elbow is not just limited to tennis players. In fact, tennis elbow is commonly diagnosed in patients between the ages of 30 and 50, and many patients have never played tennis.

Patients feel pain on the outside of the elbow and often point to a very tender spot near the lateral epicondyle bone (see image below). Symptoms can be aggravated by a forceful, repetitive activity with the hand and wrist, such as the tennis backhand swing or heavy gripping. Lifting light objects, gripping the steering wheel, and even simple household activities can be painful at times. Fortunately, the majority of patients with tennis elbow improve with non-operative treatment, although symptoms often take several weeks or months to resolve.

Golfer’s elbow, or “medial epicondylitis,” is a similar condition which causes pain on the medial, or inside, of the elbow. Both elbow pain conditions can be diagnosed in the office based on your symptoms, physical exam, and x-rays. MRI is typically not required to make the diagnosis.

 

What are the non-operative treatment options for tennis elbow?

  • Braces:   Wearing a forearm strap or wrist splint
  • Activity modification:   Resting, avoiding repetitive, heavy lifting or forceful gripping
  • Medications:   Taking anti-inflammatory medications such as Motrin, Naproxen, or Tylenol
  • Stretches:   Stretching the muscles of the hand, wrist, and elbow with exercises
  • Hand Therapy:   A therapist can guide tennis elbow exercises and perform iontophoresis, ultrasound, or therapy modalities
  • Corticosteroid injection:   Anti-inflammatory medication injection targeting the degenerative ECRB tissue can reduce pain

When is surgery recommended?

If non-operative treatment fails to improve the elbow pain after several months of conservative treatment, surgery may be recommended. During the outpatient surgery, a small portion of degenerative ECRB tissue is removed or “debrided.” This procedure is thought to stimulate healing of the normal surrounding tissues while removing the painful degenerative tissue. The type and length of incision varies among surgeons. This surgery is not a “quick fix” since returning to sports, heavy work, or weight training can take several months and additional therapy.

What are the results from surgery?

Most patients experience a significant reduction in pain, report improved function, and are satisfied with the outcome after tennis elbow surgery. However, not all patients experience complete pain relief and recovery can take several weeks to months.

Raleigh Hand Center doctors treat tennis elbow and other disorders of the hand and arm. Please call our office to be evaluated by an upper extremity specialist. 

 

Carpal Tunnel Syndrome Doctors in Raleigh NC

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Raleigh Hand Center doctors are experts in the diagnosis and treatment of carpal tunnel syndrome as well as many other conditions of the hand, wrist, elbow and shoulder. Carpal tunnel syndrome is the most common nerve problem in the hand and arm. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Hand numbness, tingling, weakness, and pain occur if the nerve is pinched in the carpal tunnel. Patients often wake up at night with the hand numb and shake out the hand to help the symptoms. 

The carpal tunnel is a space in the wrist which contains the median nerve and tendons of the hand. The carpal tunnel is a tight space. The median nerve is at risk for compression within this tunnel. If there is abnormal swelling or injury to this area, the median nerve can be irritated.

Patients with carpal tunnel syndrome commonly feel “numbness” or “tingling” in the fingers. Some patients feel that the fingers are asleep. Symptoms often wake patients up at night. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb can become weak and atrophy.

Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. A nerve test can be ordered to confirm the diagnosis. Raleigh Hand Center doctors are experts in carpal tunnel syndrome diagnosis and treatment. Please call our office for a consultation in Raleigh NC. Surgery and non-surgical care is available. 

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Wrist Injury Treatment in Raleigh NC

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Wrist injuries are very common. Treatment of wrist injuries is a specialized task because of the complexity of the area. There are 8 carpal bones including the radius and ulna bones of the forearm. There are multiple important ligaments which connect and stabilize the bones in the wrist and tendons which cross the wrist in order to move the fingers. Important nerves travel across the wrist to supply sensation to the thumb and fingers. Critical blood vessels supply nutrition and blood flow to the digits. 

Some wrist injuries are minor sprains and heal with a brace within a few weeks. Others are more severe and require casting, hand therapy, and sometimes surgery. Surgical cases include fixation of displaced wrist fractures, repair of ruptured carpal ligaments, repair of torn TFCC ligaments, decompression of the median nerve, repair of lacerated tendons, among others. Specialized evaluation is often important to make a proper diagnosis and involves a careful physical exam, history, radiographs, and possibly an MRI. For subspecialty evaluation in the greater Raleigh area please call our office for an appointment. Please watch this video from the American Society for Surgery of the Hand for additional information about broken wrists. 

Avocado Hand Injuries

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Avocado related hand injuries are on the rise. Chefs and celebrities recently have been injured while attempting to cut the fruit, bringing increased attention to the risks involved. Most people accidentally cut their non-dominant hand which is holding the avocado. The knife can slip quickly through the soft flesh and into the hand which is holding the fruit. Nerve and tendon damage are common with this type of injury. This can result in several weeks or months of recovery after surgical repair of the lacerated structures.

In order to avoid a hand injury, cut the avocado only on a stable, flat surface. Do not cut towards your hand.

If you have a hand laceration, clean the wound in running water, place a clean bandage on the wound and hold pressure to stop bleeding. If the bleeding does not stop after 5-10 minutes of firm pressure on the wound, or if you have numbness in your hand or finger, or limited finger range of motion, seek medical attention promptly. 

https://www.cbsnews.com/news/avocado-hand-injuries-on-the-rise/

Here is a video showing safe cutting technique…

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Physicians Attend Annual Hand Conferences in April

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Drs. Edwards Jr, Erickson, and Messer were at hand conferences last week and have now returned to Raleigh. Dr. Edwards Jr and Dr. Messer attended the annual Southeastern Hand Society Meeting in Florida. Dr. Erickson attended the annual Vanderbilt Hand and Upper Extremity Conference in Nashville, TN. 

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Dr Erickson Discusses Wrist Fracture Treatment at Conference

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Distal Radius Fracture

Dr. John Erickson of Raleigh Hand Center presented at UNC Orthopedic Hand Conference on Monday, 4/23/2018. His talk was titled “Preventing Complications in Distal Radius Fracture Surgery.” Local area hand surgeons, therapists, radiology staff, and ortho residents were in attendance. 

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Carpal Tunnel Doctors in Raleigh NC

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Raleigh Hand Center doctors are experts in the diagnosis and treatment of carpal tunnel syndrome as well as many other conditions of the hand and arm. Carpal tunnel syndrome is the most common nerve problem in the hand. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as hand numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.” Patients often wake up at night with the hand numb and shake out the hand for relief. 

The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. The carpal tunnel is a narrow, confined space: the floor of the tunnel is made up by the carpal bones of the wrist, and the roof is created by the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is abnormal swelling, altered wrist anatomy, or injury to this area, the function of the median nerve may be affected.

Patients with CTS commonly report “numbness” or “tingling” in the fingers. Some patients feel that the fingertips are “asleep” or report “poor circulation” in the hands. Symptoms often wake patients up at night. Some patients report increased symptoms while gripping a steering wheel. Dropping objects, clumsiness with the hands, or a weak grip are also common complaints. Some people also report pain in the forearm, wrist or fingers. In severe cases, the muscles at the base of the thumb (thenar muscles) can become weak and atrophy, sometimes permanently.

Often the diagnosis can be made on the basis of your symptoms, medical history, and physical examination. A nerve test can be ordered to confirm the diagnosis. Please call (919) 872-3171 to schedule a consultation with a hand specialist at Raleigh Hand Center. Surgical and non-surgical treatments are available.  

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