The scaphoid, one of eight small bones in the wrist, is most commonly injured due to a fall on an outstretched wrist. It occurs most frequently in young men in their teens to 30’s. A patient with a scaphoid fracture (broken scaphoid bone) will have pain on the radial (thumb) side of their wrist. They will often have pain with wrist range of motion and may also have decreased movement of the wrist. Occasionally the injury is not obvious, and patients may think the injury “is only a wrist sprain.”
If a scaphoid fracture is suspected, X-rays should be obtained. However, X-rays will sometimes fail to reveal the crack in the bone if it is small, and thus additional tests such as MRI or CT scans may be ordered.
If you have a scaphoid fracture, treatment is usually a cast or surgery. Scaphoid fractures heal slowly due to their limited blood flow. It may take several weeks or months in a cast before the fracture heals, depending on the type of fracture. Surgery is recommended for certain types of scaphoid fractures and in some patient groups. In several studies, the healing rates are better and faster with surgery versus cast treatment. Surgery can often be done through a percutaneous or minimally invasive approach, but does have some possible complications and surgical risks.
When a scaphoid fracture is not treated, the bone may not heal, and patients often experience worsening wrist pain, decreased range of motion, and stiffness. In time, these patients may develop wrist arthritis and may require surgical treatment in the future.
scaphoid fracture surgery
Raleigh Hand to Shoulder Center doctors are all board-certified by the ABOS and are members of the ASSH. Raleigh Hand to Shoulder center doctors treat patients from Raleigh, Durham, Chapel Hill, Cary, Morrisville, Apex, Knightdale, and Wake Forest, NC.
Dr. George Edwards discussed snake bite injuries at WakeMed orthopedic hand conference on Monday, February 13, 2023. Wake County has one of the highest rate of venomous snake bite injuries in North Carolina.
Arthritis at the base of the thumb (carpometacarpal joint) is a common location for arthritis in the hand. Similar to arthritis in other areas of the body, it develops from the normal wear process of our joints as we age. Typically arthritis at this joint occurs after 40-50 years of age, and is much more common in women than men.
Why does arthritis develop in this particular joint?
All joints are subject to pressure across them with normal use. Walking, for instance, causes pressure across the knee joint that over time can wear out the joint. Ligaments around the joint provide stability so there is more uniform pressure on the joint. The basilar thumb joint, or thumb carpometacarpal (CMC) joint, has significant pressure across it with normal hand use. The joint can become unstable from ligament stretching or weakening with normal aging. Over time, the combination of instability and high pressure across the joint, leads to arthritis of the thumb CMC joint.
What are the common symptoms of arthritis of the Thumb CMC Joint?
Pain in the area of the joint is typical (see above diagram for location of joint). The pain can be mild, “achy” pain early on but can progress to severe pain that limits use of the hand. Activities that involve forceful grip or pinch often increase the pain. Patients with thumb CMC arthritis often have difficulty opening jars or bottles. Use of keys can be painful as well as pulling heavy items around the home. A deformity may occur over time making it difficult to hold objects that have a large diameter.
What treatment options are available?
The physician will usually get an x-ray of the hand to confirm the diagnosis. Treatment often depends on the severity of the symptoms. In patients with mild symptoms, activity modification to avoid forceful pinch activities and occasional use of anti-inflammatory medications may be all that is required. If symptoms are more severe, splinting and cortisone injections can be used. In severe cases which do not improve with conservative treatments, surgery may be indicated.
What is involved if surgery is recommended?
Surgery can be performed on an outpatient basis under regional anesthesia. Surgical techniques vary, but typically involve removal of the trapezium bone, placing a spacer where the bone was removed, and sometimes reconstructing the joint ligaments. The patient’s own tendons can be used for a cushion/spacer and to reconstruct the joint, if necessary. In some patients a fusion of the joint or joint replacement can be considered as an alternative to the above surgery.
Dupuytren’s contracture is a common disease of the hand. This condition is known for increased fibrous tissue formation in the palms of the hands and in the fingers. Early in the course of the disease process, nodules of fibrous tissue develop in the palm. In some patients these nodules develop into cords which gradually bend the fingers into a flexed position. Over time, the finger joints become stiff and more difficult to straighten. This is called a flexion contracture. Severe contractures in the fingers can develop which significantly impair the use of the hand. Patients often have problems putting on gloves and shaking hands. Dupuytrens contracture treatment is available in Raleigh, NC.
Dupuytrens nodule in palm
Doctors have known about Dupuytren’s disease for many centuries. The condition is named after Dr. Dupuytren who was a French surgeon in the 1800s. The condition has also been called “Viking’s disease” because it is more common in people with Scandinavian ancestry. Research has increased over the past several decades. However, there is still much to be learned about Dupuytren’s.
Risk factors for Dupuytren’s disease include male sex, family history of the condition, Northern European ancestry, smoking, alcohol abuse, and diabetes. People with Dupuytren’s disease are also prone to plantar fibromatosis (Lederhosen), penile fibrosis (Peyronies), and adhesive capsulitis (frozen shoulder).
Treatment options are available for Dupuytren’s disease at various stages of the disease process. Currently, there are no cures for Dupuytren’s and no proven way to slow down the disease process. Corticosteroid injections (cortisone shots) are sometimes used to reduce pain, itching, or discomfort from Dupuytren’s nodules in the palm. Steroid injections can shrink and soften the nodules in most patients, however, the nodules often come back in the future. Radiation treatment is considered controversial for Dupuytren’s disease.
When a joint contracture has developed from a Dupuytren’s cord, there are two non-surgical treatments for Dupuytren’s contracture: needle aponeurotomy and collagenase injections. Both procedures can be performed in the office. These procedures can significantly improve finger range of motion and patients have a much quicker recovery compared to surgery. Patient satisfaction is usually high for these procedures. Not all patients are candidates for these procedures. If patients are treated in the mild to moderate stages of contracture, the results are usually good to excellent and frequently last many years.
Dupuytrens Contracture
Needle Aponeurotomy (NA) is a minimally-invasive procedure performed with local anesthesia numbing medicine in the office. The Dupuytren’s cord is perforated with a needle tip. NA is particularly useful when the primary contracture is in the palm or when a patient cannot have surgery due to medical problems. Recurrence is common with this technique, but it is a simple and inexpensive technique that can give some relief for a few years and may be repeated for recurrent contractures. Not all patients are candidates for this technique and complications include skin tears, infection, and nerve injury.
Collagenase injections (Xiaflex) were FDA approved for use in the United States in 2010. The collagenase enzyme injection is used to help dissolve Dupuytren’s cords. The injection is performed in the office and the cord is manually “popped” by the surgeon in 1 or 2 days. Although the period of time before a contracture recurs is unpredictable, recurrence of the contracture is common following collagenase injections. Not all patients are good candidates for this injection. Possible complications from collagenase injections include: tendon ruptures, skin tears, bruising, allergic reactions, and lymph node swelling.
Dupuytrens Surgery is the tried-and-true treatment for Dupuytren’s contractures in the fingers. Surgery can be performed safely in the operating room to improve finger range of motion and quality of life when patients are not candidates for the non-surgical options. This surgery is performed in the operating room under a regional block anesthetic as an outpatient. This procedure often provides good to excellent results in patients with mild to moderate joint contractures. Patients will be treated with splinting, wound care, and hand therapy for a few weeks during the recovery process after surgery. Make an appointment with a hand specialist to learn about Dupuytren’s and the treatment options recommended for your case.
Raleigh Hand to Shoulder Center doctors are specialists in carpal tunnel syndrome, among many other conditions of the hand and arm. Carpal tunnel syndrome (CTS) is a type of pinched nerve in the wrist. It is the most common compression neuropathy in the hand and arm. It results from increased pressure on the median nerve at the wrist, within the carpal tunnel. Symptoms such as hand numbness, tingling, weakness, and pain can result if the nerve is compressed or “pinched.”
The carpal tunnel is a passageway in the wrist which contain the median nerve and flexor tendons. The carpal tunnel is a narrow space made up by the bones of the wrist and the transverse carpal ligament. The median nerve is at risk for compression within this tunnel. If there is swelling, abnormal wrist anatomy, or injury to this area, the function of the median nerve may be affected.
Treatment can include wrist brace, therapy, steroid injection and surgery if conservative treatment is not successful. Surgery is usually recommended if there are signs of severe carpal tunnel syndrome or nerve damage.
A wrist fracture is a common wrist injury. This type of injury can occur from a variety of trauma, such as a fall at home or a motor vehicle collision. The distal radius is the portion of the radius bone just below the wrist joint. As we age, the bone of the distal radius loses bone mass and becomes more prone to fracture, particularly in post-menopausal women and people with osteoporosis. The distal radius may break (also called a fracture) as a result of a slip and fall in these cases. Younger patients with stronger bones may break the distal radius after high-energy trauma, such as a sports injury or car accident. Broken wrist treatment involves specialized orthopedic care, and proper healing is needed to obtain the best outcome. Wrist fracture treatment is available in Raleigh from the experts in hand and upper extremity care at the Raleigh Hand to Shoulder Center.
Broken wrist treatment depends on the severity of the fracture on the x-rays and the patient’s health and activity level. The distal radius bone usually heals after a fracture; however, a goal of treatment is for the bone to heal in a good position for function. Many people have fractures which are in good alignment. These patients do not require surgery. Treatment in these cases is typically protection in a cast or brace for several weeks. Follow-up x-rays are obtained in clinic to see how the fracture is healing. Waterproof casts for wrist fracture treatment in Raleigh are available at the Raleigh Hand to Shoulder Center. Surgery is recommended for active patients with displaced or unstable fractures, who would benefit from restoration of the alignment.
Are the surgeons at Raleigh Hand to Shoulder Center the best hand surgeons in Raleigh? See what their patients are saying!
Raleigh Hand to Shoulder Center hand surgeons
I have been utilizing the services of the Raleigh Hand to Shoulder Center for over 20 and have been completely satisfied. Everyone in the Center displays a caring attitude and that extends from the doctors down to the clerical staff. – Lee
They’re the best! Total professionalism. So knowledgeable and caring! – Janet
If ever you need any surgery or advice Raleigh Hand Center is one of the best medical offices in Raleigh. The doctors, nurses, desk staff are exceptional. I really can’t say enough as to how I was treated….they go above and beyond. Friendly, accommodating, knowledge are a few adjectives to describe the center. SUPER PEOPLE!!!!!!!!! – Wayne
This is the absolute best place that exists for any need you may have regarding your hand to shoulder! I have been beyond pleased with the care and consultation provided to my son! Dr Luchetti is the only choice for my family! – Alan
Dr Post is the best! He has performed several procedures on my left arm and both hands. He has done an excellent job each time and every experience with Dr. Post leaves me feeling like I have the best hand/arm Dr I could ever ask for. – Mitch
Dr Edwards III is a great doctor. I have the best doctor and therapist. – Netty
Dr. Erickson is the very BEST!!! Each time I’ve seen him, he listens, hears and understands my problem. All that is RARE and so appreciated!! The treatment he provides is quick, painless and very effective each time. – Lynn
This center is absolutely the best. I have had some serious hand injuries and the doctors and staff truly care about you and your recovery. Dr. Messer has been a blessing for me and my family. He goes above and beyond every visit and I have never met a more professional person in the healthcare industry. – Brooks
Dr. Luchetti did a great job with my surgery, and had excellent communication and bedside manner. I would highly recommend Raleigh Hand to Shoulder and Dr. Luchetti! – Josh
Highly recommended by other specialists in his field, Dr. Schricker is FANTASTIC! 3 other doctors recommended him to me. I’ve been a patient of his for many years. 4 Successful operations on 4 different joints. PLUS Dr Schricker is Wonderfully PERSONABLE! Top doc with personality too! – Cynthia
Dr. Erickson is a great practitioner, and a very kind person. I had two surgeries with him in 2019 and I can recommend him to all my friends and family. If you have hand, elbow, or shoulder problems, please see Dr. Erickson for the best experience. – Nataliy
Dr. Schricker is fantastic. He is extremely knowledgeable, an outstanding hand surgeon if surgery is needed, and the office is staffed by very pleasant and efficient people. I highly recommend the practice and Dr. Schricker. – Jane
Dr. Edwards III has been the best patient advocate ever. Doc has rebuilt my shoulder, my arm, my hands, and was always patient and kind. When I was injured, doc was always there. All of the nurses, doctors, and staff were wonderful.
Everyone is always friendly, courteous and professional. Dr. Post has taken care of my various hand and shoulder issues for over 10 years and has always been kind and has fixed what was resolvable & improved what couldn’t be resolved. I recommend him wholeheartedly and without reservation! – Peggy
Raleigh Hand to Shoulder Center doctors and therapists work together to achieve the best patient outcome possible. The doctors are all board-certified by the American Board of Orthopedic Surgery and are fellowship-trained in hand and upper extremity surgery. Several doctors have been named a Top Doctor. The practice has been recognized for “high-value” care: high quality healthcare at a lower cost. They would be honored to treat you or your loved one.
Raleigh Hand to Shoulder Center doctors are hand surgeons and orthopedic specialists. They are all board-certified in orthopedic surgery and have additional fellowship training in hand and upper extremity care. They take care of patients of all ages who have problems with their hands, wrists, elbows, and shoulders. They work closely with certified hand therapists (CHT) and physical therapy (PT) in the office to get the best results for their patients. The doctors use the best treatments available to help patients achieve their goals. Whether patients want to relieve pain, recover from an injury, or return to the physical activities they love, the doctors and therapists are here to improve quality of life.
Raleigh Hand to Shoulder doctors are well respected in the Wake County medical community and are among the best hand surgeons and top doctors in the area. The practice has been recognized for its high value to patients: high-quality care at a lower cost. The doctors organize a weekly teaching conference for UNC orthopedic doctors in training at WakeMed Hospital. In addition, they attend regional and national conferences to keep informed of the latest and best treatment options in hand and upper extremity care. Patients can trust they are getting the best treatment possible at Raleigh Hand to Shoulder Center.
The orthopedic doctors are experts in the treatment of carpal tunnel syndrome, wrist fractures, elbow tendonitis, rotator cuff tears, and many other conditions of the hand and arm. Not only are the physicians and therapists among the best trained in their field, they are also known for their compassion and excellent patient care. Throughout the treatment process — including before and after surgery — patients are evaluated only by the doctors and therapists in the practice. They provide personalized care without the assistance of mid-level providers, such as PAs or nurse practitioners.
Raleigh Hand to Shoulder Center strives for high-quality, compassionate healthcare and is one of the few independent, community-based orthopedic practices in the area. They are all members of the American Society for Surgery of the Hand.
Raleigh Hand to Shoulder Center doctors are hand surgeons and orthopedic specialists. They take care of patients of all ages who have problems with their hands, wrists, elbows, and shoulders. The doctors are all board-certified in orthopedic surgery and have additional fellowship training in hand and upper extremity surgery. They work closely with certified hand therapists and physical therapy in the office to get the best results for their patients. The doctors use the best treatments available to help patients achieve their goals. Whether patients want to relieve pain, recover from an injury, or return to the physical activities they love, the doctors and therapists are here to improve quality of life. Raleigh Hand to Shoulder doctors are well respected in the Raleigh medical community and are among the best hand surgeons and top doctors in the area. The doctors organize a weekly teaching conference for UNC orthopedic doctors in training. In addition, they attend regional and national conferences and keep informed of the latest best treatment options in hand and upper extremity care. Patients can trust they are getting the best treatment at Raleigh Hand.
