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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. See image below.

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.  

Update on Dupuytren’s Contracture Treatment

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Dupuytren’s Contracture is a common condition affecting the hands. Patients with this condition develop nodules in the palms followed by fibrous cords extending into the fingers. In many patients, the cords gradually contract and cause the fingers to bend or flex. If left untreated, the fingers may remain permanently bent and impair hand function. Activities such as shaking hands, wearing gloves, and reaching into a pocket can be difficult. Fortunately, if treated in the early stages of contracture, the results are usually good to excellent and the results frequently last many years.

In mild forms of the disease, intervention is not always required. Once a finger contracts to the extent where the palm cannot be placed flat on a table top, it is usually time for treatment.

There is no cure for Dupuytren’s disease. The goal of treatment is to remove or break up the contracted palmar cords to allow for improved finger range of motion and better hand function. Recurrence of the contracture is possible with any of the available treatments. There are 3 main techniques used by hand doctors today:

Surgical excision (Dupuytren’s fasciectomy): this surgery is performed by the hand doctor in the operating room under the care of an anesthesiologist. During surgery the diseased, contracted Dupuytren’s tissue is removed through incisions in the palm. Patients are treated with splinting, wound care, and hand therapy for a few weeks during the recovery process. Results from surgery can last a lifetime and typically the results last many years.

Needle aponeurotomy (percutaneous fasciotomy): this less-invasive procedure is performed by the hand doctor in the office using the tip of a needle to perforate the Dupuytren’s cord using local anesthesia. Once the Dupuytren’s cords are weakened, the finger can be manipulated and straightened. Recurrence is common with this technique, but it is the least expensive option and has minimal downtime. The technique can be repeated for recurrent contractures in the future. Not all patients are good candidates for this procedure.

Collagenase enzyme (Xiaflex): this medication is used to treat Dupuytren’s contracture and was FDA approved in the United States in 2010. Xiaflex is an enzyme which dissolves the collagen fibers in Dupuytren’s cords. The Xiaflex injection is performed by the hand doctor in the office, and later that week the patient returns for a manipulation procedure under local anesthesia. The surgeon then manually pops the cord once it has been weakened by the Xiaflex medication. Patients are instructed in home exercises and splinting by therapy, and there is minimal downtime required after the procedure. Recurrence is common with this technique, but it can be repeated for recurrent contractures. Not all patients are good candidates for this procedure.

As with any medical procedure, there are possible complications from these treatments. Complications from Dupuytren’s surgery include infection, poor wound healing, bleeding, swelling, hand stiffness, and nerve/artery injury. Complications from needle aponeurotomy include skin tears, nerve injury, and infection. Complications from Xiaflex include flexor tendon rupture, allergic reactions, hand swelling, bruising, lymph node swelling, and skin tears.

Dupuytren’s surgery, Xiaflex injection, and needle aponeurotomy are available at Raleigh Hand Center. Call 919-872-3171 to schedule a consultation with a hand doctor. 

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Dr Edwards III publishes study on pediatric hand surgery

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Dr. George Edwards, III recently published an article in the journal “Advances in Plastic and Reconstructive Surgery”. His study involved children with thumb abnormalities from birth, and evaluated surgery which could improve the child’s hand function. Dr. Edwards and colleagues at the University of Southern California performed bilateral pollicization surgeries for children with thumb hypoplasia or thumb absence. Here is a link to the article, click here

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Dr Edwards III and Dr Erickson return from Nicaragua

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Dr Erickson and Edwards III

Dr. George Edwards III and Dr. John Erickson returned from their Nicaraguan mission trip. The physicians traveled with the not-for-profit organization COAN (Cooperacion Ortopedica Americano Nicaraguense) to deliver orthopedic care to patients in Leon, Nicaragua. They also provided lectures to orthopedic residents and medical students in several teaching conferences and taught surgical techniques to residents in the operating room. The surgical cases included a wide variety of problems including chronic contractures of the fingers and wrist, nonunion of a radius fracture, chronic nerve laceration in the forearm, acute fractures of the hand, wrist and forearm, trigger fingers, and tumors of the hand and wrist. For more information about COAN, please visit their website herehttp://www.coanhealth.org

 

 

 

Operating Room in Nicaragua

 

 

Nicaragua

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Office Closure 1/18/2018 due to weather

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RHC office will be closed today Thursday January 18, 2018 due to inclement weather. We plan to open tomorrow (Friday). Be safe and warm

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Office Closure 1/17/2018 due to weather

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The Raleigh Hand Center office is closed this afternoon Wednesday 1/17/2018. We plan to re-open on Thursday 1/18/2018 at 10 AM due to inclement weather

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All Physicians are Board Certified

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All six doctors at Raleigh Hand Center are board-certified in orthopedic surgery. Additionally, the physicians have received sub-specialty fellowship training in treatment of hand and upper extremity conditions. They participate in weekly hand conferences as well as regional and national meetings dedicated to care of patients with hand and arm problems, keeping up-to-date with the latest developments in treatment. Raleigh Hand Center is the only physician practice in the area with a board-certified hand specialist on call 24-7.

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Dr. Post discusses Nerve Injuries at conference

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Dr. James Post of Raleigh Hand Center discussed the treatment of patients with nerve injuries at WakeMed UNC orthopedic hand conference on 10/30/2017. Local area hand surgeons, orthopedic residents, and therapists were in attendance. Primary surgical repair, autograft, conduit, and allograft reconstruction were discussed as treatment options.

Dr. Post

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Dr. Messer returns from Nicaraguan mission trip

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Dr. Terry Messer returns from a week-long medical mission trip to Leon, Nicaragua. 

“I recently traveled to Nicaragua with a group of doctors and nurses.  We are part of a group called COAN, a Triangle based group founded nearly 20 years ago, whose mission is to improve the quality of orthopeadic care in Nicaragua.  On our first day there, we saw more than 80 patients in the clinic with a variety of orthopedic problems, ranging from simple problems like carpal tunnel syndrome and trigger finger, to more complex problems like distal radius malunions, recurrent shoulder dislocations, severe ankle arthritis, and scoliosis.  Throughout the remainder of the week, we performed more than 30 surgeries, and we helped teach the orthopedic surgery residents and attendings at HEODRA Hospital in Leon.  In the end, our team left feeling like we received much more than we gave.  I look forward to returning to Nicaragua next year!”  — Dr. Messer, Raleigh Hand Center

Dr Messer and COAN in Nicaragua

For more information about COAN, please visit our website at coanhealth.org
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Pumpkin Carving Safety Tips

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Use caution during the Halloween season, and take steps to prevent hand injuries when carving.

“Every Halloween season we see four or five patients — both adults and children — who come into our office with severe injuries to their hands and fingers,” says Jeffrey Wint, MD, an ASSH member from The Hand Center of Western Massachusetts in Springfield, Mass. “Treatment can often run three to four months, from the time of surgery through rehabilitation.”

To prevent hand injuries, the American Society for Surgery of the Hand (ASSH) suggests the following safety tips:

CARVE IN A CLEAN, DRY, WELL-LIT AREA

Wash and thoroughly dry all of the tools that you will use, including: carving tools, knife, cutting surface, and your hands. Any moisture on your tools, hands, or table can cause slipping that can lead to injuries.

ALWAYS HAVE ADULT SUPERVISION

“All too often, we see adolescent patients with injuries because adults feel the kids are responsible enough to be left on their own,” says Wint. “Even though the carving may be going great, it only takes a second for an injury to occur.”

LEAVE THE CARVING TO ADULTS

Never let children do the carving. Wint suggests letting kids draw a pattern on the pumpkin and having them be responsible for cleaning out the inside pulp and seeds. When the adults do start cutting, they should always cut away from themselves and cut in small, controlled strokes.

SHARPER IS NOT BETTER

“A sharper knife is not necessarily better, because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it,” says Wint. “An injury can occur if your hand is in the wrong place when the knife finally dislodges from the thick skin of the pumpkin. Injuries are also sustained when the knife slips and comes out the other side of the pumpkin where your hand may be holding it steady.”

USE A PUMPKIN CARVING KIT

Special kits are available in stores and include small, serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue. “If they do get jammed and then wedged free, they are not sharp enough to cause a deep, penetrating cut,” says Wint.

HELP FOR AN INJURY

Should you cut your finger or hand, bleeding from minor cuts will often stop on its own by applying direct pressure to the wound with a clean cloth. If continuous pressure does not slow or stop the bleeding after 15 minutes, an emergency room visit may be required.

Copyright © American Society for Surgery of the Hand 2009.

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