Raleigh Hand to Shoulder Center in Raleigh, NC

Archive for the ‘Raleigh Hand News’ Category

Lumps in the Palm of the Hand

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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.

Ganglion Cyst

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. 

Dupuytren’s Nodule

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.

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.

Rotator Cuff Tear article by Raleigh Hand to Shoulder Center physician

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What is a rotator cuff tear?

A rotator cuff tear is an injury to the group of tendons/muscles that surround the shoulder joint called the rotator cuff where the tendon typically becomes torn away from the bone.  The rotator cuff is made up of the supraspinatus, infraspinatus, subscapularis and teres minor muscles and their tendinous attachment to the humerus (the arm bone). These muscles function to stabilize the shoulder and help control shoulder motion.

What are the signs of a rotator cuff tear?

A rotator cuff tear often results in a painful shoulder, particularly when trying to lift the shoulder overhead.  A larger tear can result in weakness or the inability to lift the arm overhead. The pain often is located in the shoulder and radiates down the arm partway toward the elbow.  Trouble sleeping on the affected shoulder is common.

What causes a rotator cuff tear?

A rotator cuff tear can be caused by an injury (traumatic) such as a shoulder dislocation or from a fall, or from gradual wear and tear (the most common).  Rotator cuff tears typically occur in adults and are less common in children. Repetitive overhead use of the arm over a long period of time is thought to be the most common cause of the wear and tear type of rotator cuff tear.  

What are the treatment options?

The treatment depends on the severity of the tear.  An MRI is often ordered to evaluate the problem and help determine the severity of the tear.  Most small/partial tears of the rotator cuff can successfully be treated without surgery. Often a regimen of rest, anti-inflammatories, therapy exercises, and/or corticosteroid injection can treat a small or partial rotator cuff tear.  A large tear where the tendon is pulled away from the bone would require surgery in order to repair this type of rotator cuff tear. The surgery is typically performed arthroscopically with small incisions in a minimally-invasive approach by the physicians at the Raleigh Hand to Shoulder Center.  An open surgical approach is another option for treating rotator cuff tears.

If you have signs or symptoms of a rotator cuff tear feel free to call our office to schedule an appointment with one of our fellowship trained Orthopedic hand and upper extremity surgeons that specialize in both the non-surgical and surgical treatments of shoulder pathology.

 

article by Dr George Edwards III

Video by American Academy of Orthopedic Surgeons

 

Broken Finger Treatment in Raleigh NC

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Each finger in the hand is made up of 3 phalanges: the proximal phalanx, middle phalanx, and distal phalanx. The thumb has two phalanges. A phalanx fracture, also known as a broken finger, is a common hand injury. They can occur from a variety of injuries such as a fall, a motor vehicle collision, or sports injury. Satisfactory healing of this type of injury is important to restoring the overall hand function. Early diagnosis and treatment is very helpful.

What are the treatment options?

The treatment plan will depend on the severity of the fracture as noted on the x-rays and the patient’s medical condition, activity level, and desires. Most people have fractures which are stable and well-aligned, and, therefore, do not require surgery. Treatment in these cases is typically rest and protection with a splint for a few weeks. Sometimes “buddy-taping” to the uninjured, adjacent finger can be used in stable fractures. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing. Some fractures can be re-aligned without surgery with numbing medicine, called a “closed reduction” procedure, and those patients can also be treated non-operatively. Therapy is often helpful in improving range of motion and strength after the fracture heals.

Some patients have fractures which are more displaced and the alignment of the fracture is not satisfactory. Depending on the patient’s health and activity level, surgery may be advised to improve and maintain the alignment. A fracture which heals in poor alignment (“crooked”) can significantly affect the patient’s grip strength and hand function. Fractures which injure the joint surface are more prone to complications such as finger stiffness and arthritis.

Raleigh Hand to Shoulder Center doctors can advise you about how best to treat your broken finger.

What is involved with surgery?

The surgery is performed on an outpatient basis using either local anesthesia (injected numbing medicine) or regional anesthesia (nerve block at the shoulder) often with IV sedation. During the surgery, the doctor improves the alignment of the phalanx fracture bone and uses metal implants to stabilize the bones. Fluoroscopic x-rays are used in the operating room to confirm the alignment.

In some cases, we use a small plate and screws to fix the bones internally. The orthopedic hardware is covered by the skin and soft tissues of the finger and rests against the surface of the bone. This is called “open reduction and internal fixation” and requires an incision on the finger. In other cases, we use temporary pins (K-wires) through the skin to hold the fragments aligned while the bone heals. This is called “closed reduction and percutaneous pinning.” The pins can be removed in the office after 3-4 weeks. Which technique is used depends on the fracture pattern and is sometimes determined in the operating room by the surgeon.

Surgery does not really “heal” the fracture; it simply allows the bones to be held in good alignment while the body bridges the fracture site with new bone over a few weeks.

What is the recovery from surgery like?

Your fingers and hand will be protected in a plaster splint after the surgery. Rest and hand elevation is important to reduce swelling. The splint will be removed in clinic after a few days and a removable splint will be provided by our therapists. At this point, most patients can begin gentle wrist and finger range of motion with the oversight of a hand therapist. However, some patients need an additional few weeks of immobilization to protect the repair, depending on the severity of the fracture.  

Pain, swelling, and finger stiffness gradually improve over time. Most patients can return to normal function at about 2-3 months post-operatively, but maximum improvement can take several months. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient.

https://blog.handcare.org/blog/2015/08/29/ask-a-doctor-broken-finger/

New name — Raleigh Hand to Shoulder Center

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While our name may be new, it better reflects what we have been doing for years — caring for patients of all ages with hand, wrist, elbow and shoulder problems.

RHSC2019

Elbow Pain Treatment in Raleigh NC

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One of the most common sources of elbow pain is tennis elbow. Tennis elbow, also called “lateral epicondylitis,” is a painful condition affecting many adult patients. Tennis elbow is caused by degeneration within the extensor carpi radialis brevis (ECRB) tendon on the outside of the elbow (lateral aspect). Despite the name, tennis elbow is not just limited to tennis players. In fact, tennis elbow is commonly diagnosed in patients between the ages of 30 and 50, and many patients have never played tennis.

Patients feel pain on the outside of the elbow and often point to a very tender spot near the lateral epicondyle bone (see image below). Symptoms can be aggravated by a forceful, repetitive activity with the hand and wrist, such as the tennis backhand swing or heavy gripping. Lifting light objects, gripping the steering wheel, and even simple household activities can be painful at times. Fortunately, the majority of patients with tennis elbow improve with non-operative treatment, although symptoms often take several weeks or months to resolve.

Golfer’s elbow, or “medial epicondylitis,” is a similar condition which causes pain on the medial, or inside, of the elbow. Both elbow pain conditions can be diagnosed in the office based on your symptoms, physical exam, and x-rays. MRI is typically not required to make the diagnosis.

 

What are the non-operative treatment options for tennis elbow?

  • Braces:   Wearing a forearm strap or wrist splint
  • Activity modification:   Resting, avoiding repetitive, heavy lifting or forceful gripping
  • Medications:   Taking anti-inflammatory medications such as Motrin, Naproxen, or Tylenol
  • Stretches:   Stretching the muscles of the hand, wrist, and elbow with exercises
  • Hand Therapy:   A therapist can guide tennis elbow exercises and perform iontophoresis, ultrasound, or therapy modalities
  • Corticosteroid injection:   Anti-inflammatory medication injection targeting the degenerative ECRB tissue can reduce pain

When is surgery recommended?

If non-operative treatment fails to improve the elbow pain after several months of conservative treatment, surgery may be recommended. During the outpatient surgery, a small portion of degenerative ECRB tissue is removed or “debrided.” This procedure is thought to stimulate healing of the normal surrounding tissues while removing the painful degenerative tissue. The type and length of incision varies among surgeons. This surgery is not a “quick fix” since returning to sports, heavy work, or weight training can take several months and additional therapy.

What are the results from surgery?

Most patients experience a significant reduction in pain, report improved function, and are satisfied with the outcome after tennis elbow surgery. However, not all patients experience complete pain relief and recovery can take several weeks to months.

Raleigh Hand Center doctors treat tennis elbow and other disorders of the hand and arm. Please call our office to be evaluated by an upper extremity specialist. 

 

Wrist Injury Treatment in Raleigh NC

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Wrist injuries are very common. Treatment of wrist injuries is a specialized task because of the complexity of the area. There are 8 carpal bones including the radius and ulna bones of the forearm. There are multiple important ligaments which connect and stabilize the bones in the wrist and tendons which cross the wrist in order to move the fingers. Important nerves travel across the wrist to supply sensation to the thumb and fingers. Critical blood vessels supply nutrition and blood flow to the digits. 

Some wrist injuries are minor sprains and heal with a brace within a few weeks. Others are more severe and require casting, hand therapy, and sometimes surgery. Surgical cases include fixation of displaced wrist fractures, repair of ruptured carpal ligaments, repair of torn TFCC ligaments, decompression of the median nerve, repair of lacerated tendons, among others. Specialized evaluation is often important to make a proper diagnosis and involves a careful physical exam, history, radiographs, and possibly an MRI. For subspecialty evaluation in the greater Raleigh area please call our office for an appointment. Please watch this video from the American Society for Surgery of the Hand for additional information about broken wrists. 

Carpal Tunnel Doctors in Raleigh NC

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Raleigh Hand to Shoulder Center Doctors are experts in the diagnosis and treatment of carpal tunnel syndrome. The also treat many other conditions of the hand and arm. Carpal tunnel syndrome is the most common nerve problem in the hand. It is caused 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 pinched. Patients often wake up at night with the hand numb and tingling. Carpal tunnel symptoms should be evaluated by a doctor, and not ignored.

The carpal tunnel is a passageway in the wrist through which the median nerve and tendons of the hand travel. This tunnel is a narrow and tight space. The bottom 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.

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 often wake patients up at night. 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. A nerve test can be ordered to confirm the diagnosis. Please call (919) 872-3171 to schedule a consultation with a hand specialist at Raleigh Hand to Shoulder Center in Raleigh, NC.

Surgical and non-surgical treatments are available.

Options include hand therapy, night splints, stretching exercises, cortisone injections, and carpal tunnel surgery.

Carpal Tunnel Doctors
Raleigh Hand to Shoulder Center Doctors

Raleigh Hand to Shoulder Center doctors are members of the American Society for Surgery of the Hand. They treat conditions from the fingertips to the shoulder including carpal tunnel syndrome.

Update on Dupuytren’s Contracture Treatment

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Dupuytren’s Contracture is a common condition affecting the hands. Patients with this condition develop nodules in the palms followed by fibrous cords extending into the fingers. In many patients, the cords gradually contract and cause the fingers to bend or flex. If left untreated, the fingers may remain permanently bent and impair hand function. Activities such as shaking hands, wearing gloves, and reaching into a pocket can be difficult. Fortunately, if treated in the early stages of contracture, the results are usually good to excellent and the results frequently last many years.

In mild forms of the disease, intervention is not always required. Once a finger contracts to the extent where the palm cannot be placed flat on a table top, it is usually time for treatment.

There is no cure for Dupuytren’s disease. The goal of treatment is to remove or break up the contracted palmar cords to allow for improved finger range of motion and better hand function. Recurrence of the contracture is possible with any of the available treatments. There are 3 main techniques used by hand doctors today:

Surgical excision (Dupuytren’s fasciectomy): this surgery is performed by the hand doctor in the operating room under the care of an anesthesiologist. During surgery the diseased, contracted Dupuytren’s tissue is removed through incisions in the palm. Patients are treated with splinting, wound care, and hand therapy for a few weeks during the recovery process. Results from surgery can last a lifetime and typically the results last many years.

Needle aponeurotomy (percutaneous fasciotomy): this less-invasive procedure is performed by the hand doctor in the office using the tip of a needle to perforate the Dupuytren’s cord using local anesthesia. Once the Dupuytren’s cords are weakened, the finger can be manipulated and straightened. Recurrence is common with this technique, but it is the least expensive option and has minimal downtime. The technique can be repeated for recurrent contractures in the future. Not all patients are good candidates for this procedure.

Collagenase enzyme (Xiaflex): this medication is used to treat Dupuytren’s contracture and was FDA approved in the United States in 2010. Xiaflex is an enzyme which dissolves the collagen fibers in Dupuytren’s cords. The Xiaflex injection is performed by the hand doctor in the office, and later that week the patient returns for a manipulation procedure under local anesthesia. The surgeon then manually pops the cord once it has been weakened by the Xiaflex medication. Patients are instructed in home exercises and splinting by therapy, and there is minimal downtime required after the procedure. Recurrence is common with this technique, but it can be repeated for recurrent contractures. Not all patients are good candidates for this procedure

As with any medical procedure, there are possible complications from these treatments. Complications from Dupuytren’s surgery include infection, poor wound healing, bleeding, swelling, hand stiffness, and nerve/artery injury. Complications from needle aponeurotomy include skin tears, nerve injury, and infection. Complications from Xiaflex include flexor tendon rupture, allergic reactions, hand swelling, bruising, lymph node swelling, and skin tears.

Dupuytren’s surgery, Xiaflex injection, and needle aponeurotomy are available at Raleigh Hand Center. Call 919-872-3171 to schedule a consultation with a hand doctor. 

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