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Congratulations Susie Bousquet, CHT

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Susie Bousquet completed the final step in obtaining certification in hand therapy by passing a comprehensive examination. She is now a certified hand therapist (CHT). Congratulations Susie!

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Masks Required in Doctors Offices in North Carolina

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Raleigh Hand to Shoulder Center will continue to require masks due to COVID-19 precautions. This includes patients, visits, and staff in our office.

We review the CDC and NC Department of Health guidelines for recommendations. We routinely monitor local and state COVID-19 case counts. We encourage people in the community to get vaccinated to protect themselves, their families and our community.

Updated 5/17/2021.

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Dr Edwards III gives conference on Shoulder Replacement Surgery

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Dr. George Edwards III gives a talk at WakeMed UNC Orthopedic Resident conference on May 17, 2021. His talk is on Total Shoulder Arthroplasty, also called shoulder joint replacement. Dr Edwards III is a partner at Raleigh Hand to Shoulder Center.

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Capital City Surgery Center is Best in North Carolina!

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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.

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Dr. Erickson is President of the North Carolina Society for Surgery of the Hand

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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 John Erickson
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Dr Edwards, Jr gave a talk about hand tumors

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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.

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Dr. Erickson gave talk on Pain Management

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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.

Dr John Erickson
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All our physicians are vaccinated for COVID-19

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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.

What is a ganglion cyst?

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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.

Wrist Ganglion Cyst

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!

Ganglion Cyst Aspiration

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.  

Ganglion Cyst Surgery

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.

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What is a Boxers Fracture?

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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.

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