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Pictures of Mucous Cyst in Finger

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A mucous cyst is a fluid-filled sac that occurs on the finger joint closest to the nail. The fluid is clear, thick, sticky, similar to mucous. The cyst may thin the skin and may cause a groove to form in the nail. Most patients who develop a mucous cyst have wear and tear arthritis (osteoarthritis) of the involved joint. The cyst has a stalk that is connected to the joint. It is thought that underlying bone spurs from the arthritis weakens the joint lining allowing the cyst to form.

How is a mucous cyst diagnosed?

The mucous cyst typically has a characteristic appearance, and the diagnosis is straight-forward for most hand specialists. Radiographs are usually ordered to confirm underlying arthritis of the joint and associated bone spurs (also known as osteophytes).

Does the mucous cyst need to be treated?

Most mucous cysts are not painful. If they are not causing pain or hand dysfunction, they do not require treatment. In these cases, observation for changes in the cyst is all that is needed. Some cysts can go away on their own. If a patient develops pain, recurrent drainage, or nail deformity, surgery may be recommended. Even if not painful, diagnosis should be confirmed by a physician, as other diseases may mimic a mucous cyst or ganglion cyst. These cysts should not be drained at home with a needle because a serious infection in the joint can occur. See images below for examples:

Mucous Cyst with Nail Deformity
Mucous Cyst in finger with thinning of skin
Large Mucous Cyst
Osteophyte Bone Spur

Images from Dr John Erickson

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Elective Surgery is Allowed in North Carolina

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COVID-19 Update: Effective May 1, 2020, North Carolina Governor Roy Cooper and NCDHHS Secretary Dr. Mandy Cohen have allowed elective and non-urgent procedures and surgeries to be performed in our state. Certain guidelines have to be followed including: an assessment of the medical necessity of the procedure, maintaining protective personal equipment, protecting the exposure of patients and staff, and screening for COVID-19 related symptoms. Our physicians will be resuming surgery as recommended by state guidelines.

We will continue to take precautions in our office by screening our patients and staff for COVID-19 symptoms, limiting visitors accompanying patients, asking patients and staff to wear a face covering, practice social distancing when possible, and disinfecting frequently touched surfaces. We are requiring all patients and visitors to wear a mask or face covering when in our office. We are also offering TELEMEDICINE for patients who do not wish to come in to the office.

COVID-19 symptoms include: fever, chills, shortness of breath, cough, difficulty breathing, muscle pain, sore throat, headache, new onset loss of taste or smell. Please notify your primary care physician if you are having any of these symptoms. Learn more at www.cdc.gov.

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Nerve Repair in the Hand

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Nerves are fragile and can be injured in many ways — including compression, lacerations, or blunt trauma. Compression is caused by prolonged pressure on a nerve, such as in carpal tunnel syndrome. Nerve lacerations are caused by a sharp object such as a knife or broken glass. A cut nerve in the finger will make it feel constantly numb often with tingling and electric pain. A nerve can also be injured by a sudden blunt force or “contusion” such as the thumb being hit with a hammer.

Treatment of a nerve injury depends on the type of injury, timing of the injury, and specific nerve involved. Nerves which are contused due to blunt trauma will often recover function gradually on their own, if the nerve injury is not too severe.

Surgery is recommended for most cut nerves in the hand in order to improve function and decrease the chance for neuroma formation. Without surgery, the two ends of the nerve have difficulty joining together and the numbness can be permanent. A neuroma is a thickened end of a cut nerve which can be hypersensitive to touch.  Nerve repairs in the hand are common procedures performed by hand specialists.

During nerve repair surgery, the nerve ends are brought back together and the nerve sheath is repaired using fine sutures. This is known as a “primary repair.” Magnification improves the ability to see the nerve and its tiny internal bundles called fascicles. Injured tendons are also repaired if needed. This surgery is ideally performed within a few days of the injury. 

If there has been a delay in treatment or if the nerve has been injured over a wide area, it may not be possible to bring the ends of the nerve back together. In this case a “nerve graft” can be used for nerve reconstruction to bridge the gap. There are many available sources for nerve graft reconstruction.  The three most common ways to bridge the gap are:

  1. Autografts: An autograft is a nerve graft obtained from the same patient’s body using another skin incision. Some numbness can be expected from the donor site, depending on the location of the graft.
  2. Allografts: An allograft is a nerve obtained from a person who has donated their body tissues. The grafts are cleaned and prepared carefully for this purpose. There is a very small risk of both disease transmission and graft rejection with use of allografts, but they do not require a second incision on the patient. These are commonly used today.
  3. Synthetic tubes: Synthetic hollow tubes are designed to guide the reconnection of nerve gaps. They do not require nerve harvesting from the patient but there is a small risk of graft rejection with any manufactured material.

Nerve repair surgery is not a “quick fix.” Recovery of the nerve is slow and can take 6-12 months for the feeling to come back. Recovery time varies among patients, depending on the severity of the injury, patient age, possible complications, and medical history of the patient. Not all patients regain full function after a nerve repair or reconstruction.

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SLAC Wrist Arthritis Treatment in Raleigh

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SLAC wrist is a type of wrist arthritis. SLAC stands for “Scapho-Lunate Advanced Collapse.” This occurs when the bones of the wrist abnormally wear down the cartilage surfaces, causing osteoarthritis. SLAC wrist can occur after injury to the ligaments which stabilize the wrist bones, most commonly the scapholunate ligament. Many patients had an injury which they thought was “just a sprain.” Some patients cannot remember a specific injury, since it may have occurred many years ago.

Patients with SLAC wrist notice limited range of motion, grip weakness, wrist pain, and swelling. It may be harder to use hand tools and lift heavy objects. Clicking and popping in the wrist may also occur.

Treatment options are aimed at reducing pain. Using a wrist brace during activity can reduce pain. Taking oral anti-inflammatory medications such as ibuprofen and oral Tylenol can reduce pain. Topical anti-inflammatory creams or using heat or ice can also help. Avoiding heavy use of the hand can reduce symptoms. Nutritional supplements such as turmeric and glucosamine/chondroitin sulfate may help.

Corticosteroid injections (cortisone shots) can reduce pain and inflammation in many patients, and are safe if used sparingly. Hand therapy and physical therapy does not seem to help very much.

If the pain is not well controlled and the patient cannot tolerate the symptoms, surgery may be recommended. There are several surgical options available, each with risks and benefits. The type of surgery recommended is often based on the pattern of arthritis seen on the x-rays and specific patient factors.

SLAC wrist arthritis
  • Partial wrist denervation: This surgery is designed to reduce wrist pain by removing nerves in the wrist which supply pain signals to the brain. Only selected nerves which transmit pain are cut. The nerves which provide feeling to the fingers and the nerves which control muscle movement of the hand are protected. This procedure has a quick recovery, low complication rate, but it may not fully relieve pain in some patients.
  • Proximal row carpectomy: This surgery is designed to reduce pain by removing the arthritic bones in the wrist, specifically the scaphoid, lunate, and triquetrum bones. Occasionally the tip of the radius bone is also removed if needed. This surgery allows the remaining non-arthritic bones to serve as the new wrist joint. The surgery can take 4-6 weeks to heal and not every patient gets full pain relief. About 50% of wrist motion can be maintained afterwards. In some patients this surgery can wear out and require a total wrist fusion in the future.
  • Partial wrist fusion: This surgery reduces pain by fusing together specific arthritic bones in the wrist. Often the scaphoid bone is removed during this surgery as well. Screws, staples, or a plate are options used to fix the bones, which require several weeks to heal in a cast. Smokers are at higher risk of healing complications with this procedure. About 50% of wrist motion can be maintained. In some patients, this surgery can wear out and require a total wrist fusion in the future.
  • Total wrist fusion: This surgery is the most effective at reducing wrist pain but all wrist motion is eliminated. Because the major wrist bones are fused together, the wrist does not move anymore. A plate and screws are typically used to fix the bones. As in other fusion surgeries, smokers are at higher risk of healing problems. Revision surgery in the future is not common after this procedure.
  • Wrist joint replacement (total wrist arthroplasty): This surgery replaces the arthritic joint with an artificial implant, similar to a knee replacement. This surgery is the least common option in our practice, as there are very few patients who are good candidates for this option. There is a high complication rate, such as implant loosening, breakage, infection, and revision surgery.

Your surgeon at Raleigh Hand to Shoulder Center will discuss the options which are best for your particular condition.

Article by Dr. John Erickson

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Please wear face mask when in public

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UPDATED 4/15/2020: The CDC has recently updated their recommendations about wearing face masks. There is now a recommendation that healthy people should wear a face covering such as a mask, cloth, or homemade face covering when out in public. This because it is possible to spread COVID-19 even if you do not feel sick. Medical-grade masks do not need to be used by the public.

Our office now requires that patients and their guest cover their faces when in our facility. Please bring a mask or face covering from home.

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COVID-19 in Raleigh, North Carolina, Update on 4/15/2020

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COVID-19 Update on 4/15/2020: Our office remains OPEN during the COVID-19 outbreak in Raleigh, NC. Medical practices are considered “essential” in North Carolina. Elective surgeries have been canceled, but urgent or emergent surgeries can be performed safely. For patients who do not wish to visit the office, Telemedicine or “Virtual Visits” are available. If you have a smart phone or home computer, this service can be used from the comfort of your home. Please call our office to learn more.

The Raleigh Hand to Shoulder Center physicians and staff are concerned about the spread of Coronavirus, COVID-19 disease. We are following recommendations by the Center for Disease Control and Prevention by frequently washing our hands with soap and warm water, using hand sanitizer, wiping down frequently touched surfaces, using face masks, and maintaining 6 feet distance between others when possible. We are screening patients on the phone and at the check-in area for symptoms and fevers. Our office staff are wearing face coverings and we request that patients and their guest also cover their faces with a mask or scarf, based on new CDC guidelines.

We are asking patients to reschedule their appointment if they are having fever, cough, shortness of breath or other flu-like symptoms, or if they have been in close contact with someone suspected of having Coronavirus. Our physicians and staff are monitoring themselves for symptoms and will stay home if they are showing concerning symptoms. We are asking patients to bring only one other person with them to their appointment to limit the potential spread of the virus.

We are all doing our best to keep the community safe and healthy while taking care of patients with hand, wrist, elbow and shoulder problems.

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What is elective surgery?

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Updated 3/26/2020: Governor Roy Cooper has declared a state of emergency in North Carolina due to the spread of the novel Coronavirus, COVID-19 illness. Additionally, he has suspended all “elective” surgery in the state in hospitals and surgery centers. Just what is an elective surgery? The Department of Health and Human Services in North Carolina has defined this as any surgery which if not done within 4 weeks would cause harm to the patient. At this time only surgery that is time-sensitive and needs to be done within 4 weeks will be allowed in North Carolina. 

Many surgeries in orthopedics are urgent or non-elective. These surgeries ideally should be done sooner rather than later in order to achieve the best outcome. Delay of a few weeks can result in a worse outcome. Examples of urgent procedures in hand surgery include: fracture repair, tendon repair, nerve repair, drainage of infections, stabilization of dislocated joints, ligament repair, treatment of burns, among others. If you have an injury, please seek prompt evaluation. Your doctor will decide which treatment is best, and surgery can be performed if this procedure is considered urgent.

For most patients, Raleigh Hand to Shoulder Center doctors can perform surgery at an ambulatory surgery center as an outpatient outside the hospitals. 

Urgent Conditions in the hand and arm:

  • Fractures
  • Tendon injuries
  • Nerve damage
  • Infections
  • Joint dislocations 
  • Skin lacerations
  • Ligament injuries
  • Burns
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Our office is OPEN for Medical Treatment

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COVID-19 Update: We plan to remain open during the Coronavirus outbreak to take care of our patients and to keep as many patients out of the emergency rooms as possible. Visiting your doctor is allowed under the current North Carolina guidelines for social-distancing. “Elective surgeries” have been canceled, but we are performing urgent and emergency procedures as needed.

If you have fever, shortness of breath, cough, flu-like symptoms or have been exposed to someone suspected of COVID-19, please call to reschedule your office appointment and notify your primary care physician by phone. We have started screening patients in our office to help reduce the spread of this disease in our community. We are also asking patients to bring only one other person with them to their appointment.

Please call our office if you are interested in a Telemedicine visit, which is a video visit with your doctor from the comfort of your home.

Updated 3/26/2020: Governor Roy Cooper has declared a state of emergency in North Carolina due to the spread of the novel Coronavirus, COVID-19 illness. Additionally, he has suspended all “elective” surgery in the state in hospitals and surgery centers. Just what is an elective surgery? The Department of Health and Human Services in North Carolina has defined this as any surgery which if not done within 4 weeks would cause harm to the patient. In other words, only surgery that is time-sensitive and needs to be done within 4 weeks will be allowed. 

Many surgeries in orthopedics are urgent or non-elective. These surgeries ideally should be done sooner rather than later in order to achieve the best outcome. Delay of a few weeks can result in a worse outcome. Examples of urgent procedures in hand surgery include: fracture repair, tendon repair, nerve repair, drainage of infections, stabilization of dislocated joints, treatment of burns, among others. If you have an injury, please seek prompt evaluation. Your doctor will decide which treatment is best, and surgery can be performed if this procedure is considered urgent. For most patients, Raleigh Hand to Shoulder Center doctors can perform surgery at an ambulatory surgery center as an outpatient outside the hospitals. 

Urgent Conditions in the hand and arm:

  • Fractures
  • Tendon injuries
  • Nerve damage
  • Infections
  • Joint dislocations 
  • Skin lacerations
  • Burns
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Telemedicine at Raleigh Hand to Shoulder

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We are now pleased to offer telemedicine at Raleigh Hand to Shoulder Center. This service allows you to visit with the doctor in another location using secure, video technology. In many cases, this will allow the doctor to evaluate the problem, make a diagnosis, and recommend a treatment plan.

There are risks and limitations to this type of visit. In some cases, an accurate diagnosis and treatment plan cannot be established, in which case the doctor may recommend an in-person appointment in the office. 

As a result of the Coronavirus pandemic, this method of treatment may be in the patient’s best interest as well as the health and safety of other patients and the public.

Please check with your insurance plan if telemedicine services are covered. You will be responsible for the charges if the insurance company denies the bill. 

You may use this service on any device with a camera and an internet connection, including laptops, tablets and smartphones.

We are currently using Doxy.me Telemedicine. Please call our office to set up an appointment.

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Coronavirus Update

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For the latest information about this disease, please visit the Centers for Disease Control website.

The Raleigh Hand to Shoulder Center physicians and staff are concerned about the spread of Coronavirus, COVID-19 disease. We are following recommendations by the Center for Disease Control and Prevention by frequently washing our hands with soap and warm water, using hand sanitizer, wiping down frequently touched surfaces, and maintaining 6 feet distance between others when possible. We are now screening patients on the phone and at the check-in area for symptoms. We are asking patients to reschedule their appointment if they are having fever, cough, shortness of breath or other flu-like symptoms, or if they have been in close contact with someone suspected of having Coronavirus. Our physicians and staff are monitoring themselves for symptoms and will stay home if they are showing concerning symptoms. We are asking patients to bring only one other person with them to their appointment to limit the potential spread of the virus. We are all doing our best to keep the community safe and healthy.

Infectious disease experts have recommended frequent hand washing with warm water and soap for 20 seconds, avoiding sick contacts, staying home if you are sick, using a disposable tissue for sneezing, avoid touching your face, and wiping down frequently touched surfaces. Face masks have not been recommended for healthy people trying to avoid getting sick.

If you have flu-like symptoms, please call to reschedule your office appointment and notify your primary care physician by phone.

Flu-like symptoms include: Fever, cough, fatigue, body aches, sore throat, chills, or shortness of breath

Updated 3/16/2020

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