Raleigh Hand to Shoulder Center is pleased to welcome Dr. Timothy Luchetti to the practice. Dr. Luchetti was born in Harrisburg, PA. He received his doctorate in medicine from the Columbia University College of Physicians & Surgeons in 2014. His orthopedic internship and residency occurred at Rush University in Chicago, IL, where he was directly involved in the care of athletes from the Chicago Bulls and Chicago White Sox. He completed his specialty training in Hand & Upper Extremity Surgery at the University of Pittsburgh Medical Center in 2020. Dr. Luchetti is a member of the American Academy of Orthopedic Surgeons and the American Society for Surgery of the Hand. He is board eligible in orthopedic surgery. He is married and has one daughter. He is an avid Notre Dame football fan. In his spare time, he enjoys cycling, playing piano, and reading science fiction novels.
Dr. George Edwards, Jr. retired on May 1, 2022 after 38 years of hand and upper extremity surgery in Raleigh. He thanks all the office, surgery center and hospital staff for their unwavering support in caring for our patients. Drs. Post, Schricker, Messer, Erickson and Edwards, III will continue to offer care seamlessly for new and follow-up patients. Dr. Tim Luchetti will join RHSC the first of August, 2022
Dr. James Post of the Raleigh Hand to Shoulder Center gave hand conference at WakeMed Raleigh hospital campus. He discussed treatment options for patients with distal radius fractures, also known as a broken wrist.
Dr. John Erickson of the Raleigh Hand to Shoulder Center discussed the treatment options for patients with persistent or recurrent carpal tunnel syndrome following surgery. He presented hand conference on Monday, 2/7/2022 at WakeMed Raleigh campus.
Dr. Terry Messer of Raleigh Hand to Shoulder Center discusses treatment options for patients with metacarpal fractures in the hand on Monday 12/20/21 at WakeMed orthopedic hand conference. Non-surgical and surgical treatment options as well as hand therapy are emphasized.
Many patients say: “my doctor said there is nothing we can do for arthritis.” It is true that doctors cannot cure arthritis, but treatment of hand arthritis is available.
What is arthritis? Arthritis is a common source of hand pain in patients older than 40 years of age. Osteoarthritis is the most common type of arthritis. This is also known as degenerative joint disease. Osteoarthritis is caused from normal “wear and tear” occurring gradually over time. The small joints in the fingers and the large joint at the base of the thumb are commonly affected areas in the hand. Rheumatoid arthritis, psoriatic arthritis, and gout arthritis are other specific types of arthritis, which are less common.
What are the signs of arthritis? Patients often describe a gradual onset of “dull ache” pain in the joints and morning stiffness in the fingers. In some patients, the stiffness in the fingers gets worse and the patient notices decreased range of motion in the hand. Some of the knuckles can develop prominent bumps, which are seen as bone spurs or “osteophytes” on x-rays. These bumps are called Heberden’s nodes. In more severe cases, the fingers can develop deformity and appear crooked. Not everyone with arthritis develops deformity or much pain, however.
What causes arthritis? There are many factors which contribute to osteoarthritis including family history, injuries, inflammation, and age. The joints in our bodies are made up of cartilage, which cushions and protects the end of the bones. The cartilage allows for full range of motion. Over time, this protective cartilage becomes thin and wears away. In some patients, the cartilage surface is worn out and there is “bone-on-bone” grinding at the joint, which can be painful. This “wear and tear” process can be increased after an injury.
What is a treatment of hand arthritis? Although there is no cure for arthritis, there are several treatments which can help reduce the symptoms. Simple things patients often try at home are warm water soaks in the morning, range of motion exercises with the fingers, and warm paraffin wax dips. There are many over-the-counter products which may help such as oral medications, dietary supplements, and topical ointments. Use of oral anti-inflammatory pills (Tylenol, Ibuprofen, Naproxen, etc.) can reduce pain temporarily. NSAIDs should be used sparingly due to side-effects. Anti-inflammatory creams can be purchased over-the-counter and applied to the skin over a painful joint. Additionally, doctors can prescribe hand therapy and various types of braces to help support arthritic joints. Corticosteroid injections (cortisone shots) can be used sparingly for a painful joint to reduce pain and swelling.
Is surgery needed for hand arthritis? Most people do not require surgery for hand arthritis. If patients have tried non-surgical treatment and still have severe pain, surgery might be recommended. Depending on the patient and the affected area, either joint replacement or joint fusion surgeries are options. The base of the thumb joint can be treated surgically with arthroplasty, which can significantly decrease pain and improve hand function. Your hand surgeon can discuss these options with you.
There are many treatments available for carpal tunnel syndrome (CTS). If the hand numbness and tingling symptoms come and go, non-operative treatment is appropriate. People who have severe carpal tunnel syndrome should be evaluated by a hand surgeon. Constant numbness in the hand and loss of muscle tone at the base of the thumb are signs of nerve damage and severe CTS. Surgery is the best way to prevent the nerve from being damaged. If people wait too long before having surgery, some of the hand numbness and weakness can be permanent. The Raleigh Hand to Shoulder Center surgeons offer the best treatment for carpal tunnel syndrome. They are among the top doctors in the field of hand surgery.
Not all hand pain, numbness, and tingling are caused by CTS. If the symptoms are getting worse or not responding to treatment, a hand specialist should be consulted sooner rather than later.
The recommendations below are intended for Raleigh Hand to Shoulder patients with mild to moderate CTS symptoms. There are some things we can’t change about our health, such as our family history, age and hand anatomy. However, there are many things that we can modify to improve our health.
Helpful treatments other than surgery for carpal tunnel syndrome:
— Wearing a wrist brace at night
— Hand and wrist stretching exercises
— Hand Therapy
— Smoking cessation
— Steroid injection
Treatments which are NOT
helpful for carpal tunnel syndrome:
— Magnet therapy
— Laser therapy
— Long-term use of oral NSAIDs
— Expensive custom braces
— Most products on the internet claiming to be a cure for carpal tunnel syndrome
Raleigh Hand to Shoulder Center hand doctors are experts in the diagnosis and treatment of carpal tunnel syndrome. They are members of the premier hand society, American Society for Surgery of the Hand. Several surgeons have been named top doctors in the area.
Lumps and bumps in the palm of the hand are very common. Patients should seek evaluation by a trained physician to make the diagnosis. Below are the most common causes of lumps in the palm.
The most common cause of a hand lump in the palm of the hand is a ganglion cyst. These are fluid filled sacs which come from the joint or tendon fluid in the hand. Ganglion cysts are not cancer. They often fluctuate in size and can go away on their own. If the cyst is painful, it can be drained with a needle by a doctor or removed by a hand surgeon. Drainage of the cyst with a needle is a simple treatment in the office, but the cyst comes back about 50% of the time. After surgery, the chance of recurrence is 5-10%. If the cyst is not painful or bothersome, it does not require treatment.
Another very common cause for a lump in the palm is due to Dupuytren’s disease. These lumps are called Dupuytren’s nodules. Dupuytren’s nodules are made up of abnormal scar tissue. Dupuytren’s is more common in males of Caucasian ethnicity. Sometimes it is called Viking’s disease because it is prevalent in Scandinavian, Scotch-Irish, and Northern European populations where the Viking’s lived. In many cases the condition occurs in both hands and it runs in families. Most of the time the nodule is not painful, but in some patients it is tender or sore to the touch. Tender nodules can be injected with steroid to reduce the soreness and size of the nodule.
Giant Cell Tumor of Tendon Sheath
Giant Cell Tumors are common tumors in the hand. These are typically firm and slow growing. They can be painful if they press on a nerve or grow to a large size. They are not cancer. Usually these are treated by a surgeon with excision in the operating room. These tumors may come back after surgery. The cause of these tumors is not known but they are usually near a joint or tendon in the hand.
Epidermal Inclusion Cyst
Epidermal Inclusion Cysts are common following trauma or lacerations to the skin of the hand. These are usually slow growing and occasionally tender. These cysts are made of up keratin material shed from skin cells within the lesion. This is a thick, white-yellow, cheese-like substance. Surgery is usually recommended for epidermal inclusion cysts. Recurrence of the cyst after surgery is very low.
There are several other causes for lumps in the palm including: lipomas, nerve tumors, neuromas, blood vessel tumors, and cancers. Please seek evaluation with a trained physician to make the diagnosis. Hand surgeons are experts in the diagnosis and treatment of hand lumps, bumps, cysts, and tumors.
Raleigh Hand to Shoulder Center hand doctors are experts in the diagnosis and treatment of hand disorders including lumps in the palm of the hand. They are top doctors in the field of hand surgery.