Dr. George Edwards, III of Raleigh Hand to Shoulder Center will be discussing congenital hand problems at WakeMed UNC orthopedic resident conference on Monday, February 3rd. This talk includes a discussion of various birth abnormalities involving the hand including treatment options.
Dr. Terry Messer of Raleigh Hand to Shoulder Center and Dr. William DeAraujo of Goldsboro Orthopaedics recently traveled to Leon, Nicaragua for a medical mission trip. They worked with the Resident and Attending doctors at HEODRA Hospital where they saw approximately 100 patients and performed more than 25 surgeries during the week. Several doctors from RHSC have participated in medical mission trips to Nicaragua in recent years.
Hand arthritis is typically diagnosed with x-rays. Osteoarthritis (OA) is the most common form of arthritis. This is caused by wear-and-tear, genetics, injuries, and it is often a normal part of the aging process. An arthritic joint will show decreased space between the bones as the cartilage thins, bone spurs or calcium deposits on the edges of the joint, small cysts within the bone, and sometimes deformity of the joint, causing it to look crooked. See the x-rays below for common findings in osteoarthritis of the hand and compare this to the normal hand x-ray. The joints closest to the fingertip (DIP joints) and the joint at the base of the thumb (thumb CMC joint) are the most common joints in the hand affected by osteoarthritis. Of note, the letters on the xray images are NOT patient initials.
Tennis elbow, also known as “lateral epicondylitis,” is a painful condition affecting many patients. Tennis elbow is caused by degeneration within the extensor carpi radialis brevis (ECRB) tendon on the outside of the elbow. 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 years, many of whom have never played tennis.
Patients experience pain on the outside of the elbow and often point to a very tender spot near the lateral epicondyle bone. 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 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.
Treatments usually involves stretches, wearing a wrist brace or forearm strap, therapy, oral anti-inflammatory medications, and corticosteroid injections. Surgery is occasionally needed if the patient does not respond to conservative treatment.
All six doctors at Raleigh Hand Center are dual board-certified in orthopedic surgery and hand 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.
Read the recent article by Jonah Kaplan of ABC-11 news about independent medical practices in the Triangle. Raleigh Hand to Shoulder Center is one of the few independent physician practices in the area.
In most cases the diagnosis can be made based on symptoms, medical history, and physical exam in the clinic. A corticosteroid injection into the carpal tunnel (cortisone shot) can be used for treatment and diagnosis. An electrodiagnostic study (nerve conduction study) can be ordered to confirm the diagnosis in some cases, but is not always required. Hand surgeons are experts in making the diagnosis of carpal tunnel syndrome and ruling out other causes of symptoms.
Many patients with CTS improve with use of a wrist brace at night or a cortisone injection. Surgery is recommended in cases of severe carpal tunnel syndrome (signs of nerve damage) or if conservative treatment is not successful.
Patients with carpal tunnel syndrome (CTS) feel “numbness” or “tingling” in the fingers. Some patients feel that the hands are “asleep” and have poor circulation from time to time. Symptoms are often worse at night and wake patients up from sleep. Patients tend to shake out their hands for relief. Dropping objects, clumsiness with the hands, or a weak grip are also possible complaints. Some patients also report burning, electric or pins and needles type pain in the wrist or fingers. In severe CTS, the hand is constantly numb in the thumb, index and middle fingers, and there is atrophy in the thumb muscles.