Capital City Surgery Center (CCSC) was recently named the #1 Ambulatory Surgery Center in North Carolina! The Raleigh Hand to Shoulder Center physicians use CCSC for the majority of their outpatient surgeries and they are proud of the national and state recognition. The doctors have financial interest in the surgical facility.
Dr. John Erickson is the 2021 president of the North Carolina Society for Surgery of the Hand (NCSSH). The 2021 annual meeting will be in Pinehurst, NC in October. The NCSSH is a non-profit, professional organization of North Carolina hand surgeons.
Dr. George Edwards, Jr. of the Raleigh Hand to Shoulder Center discussed soft tissue masses and tumors of the hand and wrist at WakeMed Hospital UNC Orthopedic Resident Hand Conference on Monday, March 8, 2021. Diagnostic work-up, treatment, and prognosis of various hand lesions were discussed.
Dr John Erickson gave a lecture at the WakeMed Hospital UNC Orthopedic Hand Conference on Monday, February 8, 2021. His talk was titled, “The U.S. Opioid Epidemic: The Role of the Orthopedic Surgeon.” He discussed pain management techniques to improve patient satisfaction while minimizing risks of opioids.
The doctors at Raleigh Hand to Shoulder Center have received 2 doses of the COVID-19 vaccine. Vaccines for employees in the office are well underway. We will continue mask wearing and hygiene protocols — we are doing our part to slow the spread of the coronavirus. Additionally, all of our therapists are also fully vaccinated for protection against COVID-19.
A ganglion cyst is a very common bump in the hand and wrist. These cysts usually arise near a joint or tendon in the hand and wrist. The most common location is the back of the wrist (see image below). They can occur in people of all ages and are common in young adults. The cause of a ganglion cyst is unknown in most cases. One theory is that the cyst arises from joint fluid which has leaked from a small opening in the joint capsule. The cyst is filled with a thick, jelly-like fluid and usually has a connection with a joint or tendon below. Many patients report that the cyst fluctuates in size, and in some cases the cyst can go away on its own.
Most ganglion cysts are diagnosed by history and physical exam by a trained physician. Since ganglion cysts are fluid-filled, a light shined directly on the mass will illuminate the cyst. X-ray, ultrasound, and MRI testing are not usually required to make the diagnosis in typical cases.
What are the treatment options? There are three common treatments for a ganglion cyst in the wrist:
OBSERVATION: Also known as watch and wait. Since ganglion cysts are benign (not cancer), surgery is not required to remove them. Cysts which are not painful and do not interfere with function can be left alone and monitored. Some cysts can go away on their own. If the cyst becomes larger, painful, or interferes with function, further options should be discussed.
ASPIRATION: Also known as drainage with a needle. The cyst can be punctured and the thick fluid removed using a needle under sterile conditions. This is a quick procedure which is performed in the office. There is a high chance that the cyst comes back, however. There is a small risk of bleeding, pain, and infection from this procedure. Do NOT try this at home!
SURGICAL EXCISION: Excision of a ganglion cyst is performed in the operating room and requires an incision. During surgery, the cyst is removed including the base which goes down to the joint below. Removal of the connection to the joint reduces the chance of recurrence. Gardeners realize that the roots of the weed need to be removed, or else it will grow back.
In the past, some physicians have recommended simply popping the cysts by hitting them with a heavy book or Bible. For this reason ganglion cysts have been called “Bible cysts.” This is not recommended since damage can be done to the surrounding area and most cysts recur with this technique.
What is the recovery from ganglion cyst excision surgery? Ganglion cyst excision is performed on an outpatient basis. Most people can return to light duty work in a few days as the pain and swelling subside. Hand therapy is sometimes helpful after this procedure to improve range of motion and strength. Patients should avoid forceful use of the hand for approximately 4 weeks after surgery. Normal use of the hand is resumed as comfort allows. Complications from surgery include cyst recurrence (5-10%), wrist stiffness, scar tissue, and infection.
The ganglion cyst images are copyright Dr John Erickson and the cyst aspiration drawing is copyright AAOS OrthoInfo. The video is courtesy of American Society for Surgery of the Hand.
Boxer’s fractures are very common hand injuries. The typical cause is punching a wall with a clenched fist. These injuries are most common in young adult males. They can also occur from a variety of ways such as a fall, sports injury, or car accident. A “boxer’s fracture” is defined as a fracture of the 5th metacarpal neck. “Fracture” is simply the medical term for “broken bone.”
There are five metacarpals — one for each finger and the thumb. The 5th metacarpal is at the base of the pinkie. Bruising, swelling, pain, and finger stiffness are common symptoms at first. The knuckle may look abnormal or out of place as well.
The recommended treatment of this injury depends on the alignment of the fracture as noted on the x-rays and the patient’s medical condition and activity level. Most patients have boxer’s fractures which have mild to moderate angulation and, therefore, do not require surgery. Angulation is measured in degrees and this defines how “crooked” the bone is. A firm “bump” is often noticed at the fracture site during healing. This is composed of new bone formation, the body’s normal response to heal the fractured bone. This can be seen on x-ray and is called the “fracture callus.”
Mild to moderate angulation in a boxer’s fracture typically results in a good long term outcome. Our hands can naturally compensate for this deformity and still function very well due to the motion at the base of the 5th metacarpal. This is because the joint at the base of the 5th metacarpal has a high degree of mobility. Treatment in these cases is typically rest and protection in a splint or cast for 4-6 weeks. Ice, compression, elevation and oral NSAIDs are helpful to reduce hand swelling. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing, and therapy is often helpful to improve finger range of motion and hand strength.
If the fracture angulation is excessive, or the metacarpal alignment is poor, the bone can be re-aligned with manipulation. This procedure is called a “closed reduction” and is performed in the office with local anesthesia numbing medicine. These patients can be treated without surgery and achieve a good result.
Occasionally, surgery is recommended to fix the fracture with metal implants such as pins, screws, or a plate. Surgery is most beneficial if there is significant angulation or if the finger is mal-rotated (twisted). Surgery has the potential complications of infection, stiffness, scar tissue formation, and need for removal of the metal implants.
Your doctor will explain the options to you and recommend individual treatment based on your specific type of injury.
Capital City Surgery Center (CCSC) was recently named the #1 Ambulatory Surgery Center in North Carolina! The Raleigh Hand to Shoulder Center physicians use CCSC for the majority of their outpatient surgeries and they are pleased with the national and state recognition. The doctors have financial interest in the surgical facility. Read the article here.
Carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremity. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.”
The word “carpus” is derived from the Greek word karpos, which means “wrist.” 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.
What causes carpal tunnel syndrome?
In most cases, the cause of CTS is unknown. Thyroid disorders, rheumatoid arthritis, pregnancy, vitamin deficiencies, diabetes, fluid retention, and trauma can be associated with CTS. Women are more commonly affected than men. Repetitive, forceful gripping and heavy use of vibratory tools may increase a person’s risk of CTS.
How do I know if I have carpal tunnel syndrome?
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 are often worse at night and people tend to shake their hands for relief. 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. An electrodiagnostic study (nerve conduction study and/or electromyogram) can be ordered to confirm the diagnosis.
What are the treatment options?
Not everyone with carpal tunnel syndrome needs surgery. Fortunately, many people with CTS improve with non-operative treatment. Wearing a wrist brace at night supports the wrist in neutral alignment and takes pressure off the median nerve. Avoiding prolonged wrist flexion and forceful or repetitive gripping may also help. Corticosteroid injections provide an anti-inflammatory effect and can be effective in many patients.
Should these measures fail to improve the condition, or if nerve compression is severe, surgery may be recommended. A carpal tunnel release (CTR) is performed to decrease pressure on the median nerve. During this procedure, the “roof” of the carpal tunnel (the transverse carpal ligament) is divided. Cutting the transverse carpal ligament increases the size of the carpal tunnel and provides more room for the median nerve.
The length and type of incision varies among surgeons; however, the common goal is to reduce pressure on the median nerve. The length of incision used for CTR has decreased in size since the procedure was invented decades ago due to advancement in surgical techniques. Open CTR and endoscopic CTR are two surgical options. The recommended procedure will be discussed with you in the clinic.
What is the recovery from surgery?
The surgery is performed as an outpatient under local anesthesia. Oral or intravenous sedation medication may also be used. Patients may use their hands for light activities soon after the surgery. Many people can return to light duty work in a few days. Patients should avoid heavy use of the hand for approximately 3-4 weeks after surgery. As the pain from surgery subsides, normal use of the hand is resumed.
What are the results from carpal tunnel surgery?
Most patients are very satisfied with their outcome after CTR surgery. Many patients report dramatic improvement in their symptoms in just a few days, but others may take longer. Some patients do not have complete relief of symptoms, especially in severe or long-standing cases. Temporary soreness or tenderness in the palm can occur. There is less than 5% recurrence rate after CTR surgery.
What are the complications from surgery?
Complications from carpal tunnel release surgery are uncommon. Possible complications include persistent symptoms, pain, bleeding, infection, stiffness, and damage to the median nerve.
Dr. George Edwards III discusses treatment of metacarpal fractures of the hand at WakeMed orthopedic hand conference on August 24, 2020. Diagnosis, non-operative treatment, modern surgical techniques, and rehabilitation programs are discussed.