Got Thumb Pain? Arthritis Could Be the Suspect

arthritis hand indiana hand to shoulder centerIf you notice increasing pain with activities as simple as opening a jar or turning a key, you likely are experiencing the effects of thumb arthritis, also known as basal joint arthritis. This condition is common in postmenopausal women, with nearly 25 percent of women eventually developing pain and other symptoms due to wear and tear on the joint at the base of the thumb.

For most women, thumb arthritis is not from prior injury. Men suffer from the condition with fewer incidences than women; however, male patients will frequently have a history of a prior injury.

The anatomy of the thumb basal joint depends upon two bones – the trapezium and the thumb metacarpal – along with several ligaments to maintain stability. These bones and ligaments are placed under tremendous stress on a daily basis. For example, if we pinch the equivalent of 10 pounds at the fingertip, the basal joint is placed under 120 pounds of pressure. During grasp, the basal joint may experience over 100 times the force. This repetitive force causes the ligaments to become thin, which leads to abnormal wear and, eventually, arthritis.

Treatment depends on the severity of the disease. Early disease typically responds to splinting and simple injections. As more conservative treatments become less effective and symptoms become unbearable, surgery becomes the best option for pain relief without limiting function.

Diagnosis is pain free. A simple evaluation and review of radiographs with an orthopedic surgeon usually is all that is necessary. Once diagnosis is confirmed, the physician and patient can tailor a team approach for the most effective treatment regimen.

James B. Steichen, M.D. awarded the Pioneer of Hand Surgery by the International Federation of Societies for Surgery of the Hand

James B. Steichen, M.D., one of the original founders of The Indiana Hand Center, was recently awarded the “Pioneer of Hand Surgery” by the International Federation of Societies for Surgery of the Hand in Buenos Aires, Argentina. The IFSSH awards “Pioneer of Hand Surgery” status to any person who excels exceptionally, beyond what is normally expected in the field of hand surgery. The enormous contribution of the Pioneers to Hand Surgery will influence many generations of Hand Surgeons to come. Ultimately of course, their accomplishments will benefit countless patients far into the future. Current partner Thomas J. Fischer, M.D. was in Buenos Aires to receive the award.

james_b_steichen_award_1“Dr. Steichen was always devoted to his patients and always devoted and dedicated to education of his fellows. He was a classic educator who taught you how to take care of patients in the best way possible by example. He was an excellent clinical surgeon with skills that his fellows desired to emulate. He was an organized articulate lecturer. He taught his fellows how to approach complex problems in a logical fashion; and once I was in practice, he was the partner that I would go to for advice when I was presented with either difficult patients or difficult problems that I needed to solve.” said Jeffrey A Greenberg, M.D., who trained under Dr. Steichen as a fellow and worked with him as a partner at the Indiana Hand to Shoulder Center.

Dr. Steichen’s professional career began at the University of Illinois College of Medicine. He graduated with an MD degree in June 1967. He then went on to complete an internship at Rush Presbyterian St. Luke in Chicago, Illinois; and ultimately, completed his residency in orthopedic surgery at St. Vincent Hospital in Indianapolis, Indiana. Concurrent with his final 6 months of orthopedic residency, Dr. Steichen completed a fellowship in hand surgery with Dr. Jim Strickland at The Indiana University School of Medicine and St. Vincent Hospital. Dr. Steichen was certainly a pioneer as subspecialty orthopedic fellowships were not routinely completed in the early 1970s. Following his residency and fellowship, Dr. Steichen served 2 years in the United States Army at Reynolds Army Hospital in Fort Sill, Oklahoma, where he was the chief on the orthopedic service with a rank of Major.

Following military service, Dr. Steichen’s interest in microvascular surgery was evident as he sought additional training at a time when microvascular upper extremity reconstruction was in its infancy. Dr. Steichen was a research fellow in microsurgery with Mr. Bernie O’Brien at the St. Vincent Hospital Microsurgery Research Center in Melbourne, Australia. He spent time with Dr. Tsuge and Dr. Ikuta at Hiroshima University School of Medicine Department of Orthopedic Surgery in Hiroshima, Japan, and with Dr. Harry Buncke at The Ralph Davies Medical Center Franklin Hospital in San Francisco, California.

Dr. Steichen then returned back to Indiana where he started his clinical practice solely devoted to hand and upper extremity reconstruction with an emphasis on microvascular reconstruction. He and Dr. Jim Strickland cofounded the Indiana Hand Center (now known as Indiana Hand to Shoulder Center).

Dr. Steichen was the first vice president of The Indiana Hand Center from 1975 to 2000, member of the board of directors from 1975 to 2006, and the managing partner from 1988 to 1992. Dr. Steichen held hospital appointments at St. Vincent Hospital, Indiana University School of Medicine Hospitals including University Hospital, Riley Hospital for Children, Robert W. Long Hospital, Roudebush Veterans Administration Medical Center and Wishard Memorial Hospital. He also had appointments at Methodist Hospital of Indiana, Community Hospital of Indianapolis, Winona Memorial Hospital, Decatur County Memorial Hospital and at The Surgery Center of Hand Surgery Associates of Indiana. He held academic appointments at the Indiana University School of Medicine and was a clinical assistant professor from June of 1975 to 1982, a clinical associate professor from 1982 to 1989, and achieved the rank of clinical professor of orthopedic surgery in July 1989. He also held academic appointments at the University of Kentucky Medical Center in Lexington, Kentucky eventually achieving the rank of associate professor of plastic surgery on the voluntary faculty.

In 1972, Dr. Steichen was the first fellow in the Indiana Hand Center program. Once he began his clinical and academic practice, he was an integral part of the faculty, educating fellows and residents in hand and microvascular surgery. The fellowship that he helped establish was based out of Indiana University Medical Center and St. Vincent Hospitals and has developed into one of the most prestigious and sought after hand, upper extremity and microvascular fellowships in the United States. Dr. Steichen provided clinical teaching for nearly 200 fellows until his retirement in 2006. Many of the fellows that he influenced have gone on to lead strong academic hand surgery careers and many of his former fellows have become influential leaders in the field of hand surgery and various hand surgical societies. In addition to teaching hand fellows, Dr. Steichen was also involved in the education of the orthopedic and plastic surgery residents from Indiana University. He also instructed plastic surgery residents from the University of Kentucky that would travel to Indianapolis to do their hand surgery rotations. Over the years, he also influenced a number of residents and young attendings that visited the center not only from the United States, but from countries world-wide.


The majority of Dr. Steichen’s research interest had to do with microvascular reconstruction. Dr. Steichen was the founder and the former director of the microvascular surgery lab for fellow and resident training and research in Indianapolis. As part of his research activities, he was integral to the development of the 3M microvascular anastomotic coupler. He worked extensively with the 3M company researching and developing this device prior to its release and taught extensively nationally and internationally on its use. In 1991, Dr. Steichen was awarded the Sumner L. Koch award at the annual meeting of the American Society for Surgery of the Hand. Dr. Steichen also received 3 grants for clinical research projects including projects to evaluate upper extremity outcome following radial artery harvesting for coronary artery bypass surgery, a prospective evaluation of the 3M microvascular anastomotic system, and a grant to investigate the design and development of microsurgical instruments, which were eventually manufactured and distributed by Stille-Werner and are still in use today.

Dr. Steichen has edited or co-edited 3 books. Difficult Problems in Hand Surgery was published in 1982 and was a textbook that surgeons would refer to when faced with uncommon or difficult problems that were not addressed in more traditional text books of hand and upper extremity surgery. He worked with other microvascular surgeons to develop a Microsurgery Skills laboratory manual, which was published in 1984 and was a manual that budding microvascular surgeons could refer to as they were developing microvascular reconstructive skills. Finally, he worked with Dr. Tsuge on the Comprehensive Atlas of Hand Surgery, and he was the editor of the English language text version of this atlas published in 1989.

Dr. Steichen’s abilities as a clinical and academic educator reached a worldwide audience. Over the course of his career, he not only was involved locally and nationally, but also participated in many international societies. He was either a honorary or corresponding member in the Italian Microsurgery Society, the South African Society for Surgery of the Hand, the Venezuelan Society for Surgery of the Hand, the Brazilian Society for Surgery of the Hand, Colombian Society for Surgery of the Hand, the Swiss Society for Surgery of the Hand, the Group for the Advancement of Microsurgery in Canada, the Brazilian Society of Reconstructive Microsurgery, French Society for Surgery of the Hand, Japanese Society for Surgery of the Hand, Luxembourg Medical Society, and the National Academy of Surgery of France. He served as the president of the International Society of Reconstructive Microsurgery from 1993 to 1996 and was active in that organization since 1985. He was the vice president of the Pan-Pacific Surgical Association and also a member of the International College of Surgeons, International Federation of Societies for Surgery of the Hand, Group Pour L’advancement de la Microchirurgie Canada, the International Society of Reconstructive Microsurgery, the Pan-Pacific Surgical Association, the Societe Internationale de Chirurgie, The Bernie O’Brien Society, and Harry J. Buncke Society.

On a national level, Dr. Steichen was also very active, he has been invited to address groups all over the United States more than 60 times. He has been a member of the American Medical Association, the American Fracture Association, the American Society for Surgery of the Hand, the American Academy of Orthopedic Surgeons, the American College of Surgeons, the Hand Study Society, the American Society for Reconstructive Microsurgery, American Orthopedic Association, and the American Association of Orthopedic Surgeons. He was a very active member in the American Society for Surgery of the Hand serving as a chairman on a number of committees and task forces. He served as the chairman of the annual meeting program committee, the annual residents and fellows conference committee, the American Federation Task Force committee, the chairman of the combined meeting of the American and Japanese Societies for Surgery of the Hand, the chairman of the hand surgery practice committee, and also served on the executive council as a member at large from 1983 to 1985. He was also active in the American Society for Reconstructive Microsurgery serving not only on a number of committees, but on the executive committee including serving as the president in 1989. Over the course of his career, Dr. Steichen was the recipient of numerous professional awards and honors. He received the physician’s recognition award from the American Medical Association. He received the distinguished physician award from St. Vincent Hospital and Health Services. He received the Docteur Honorist Causa awarded by the University Henri Poincare in Nancy, France. He was nominated to the honorary council of Luxembourg. He was awarded a Sagamore of the Wabash by the Governor of the State of Indiana and also the physician community service award by the Indiana State Medical Association. Dr. Steichen was also recognized by the general assembly of the State of Indiana for his 25-year contribution to medicine in the state of Indiana in 2001.

The partners of the Indiana Hand to Shoulder Center are appreciative that the International Federation of Societies for Surgery of the Hand has recognized the great contributions of Dr. Steichen. The Indiana Hand to Shoulder Center continues to thrive in the tradition and mission that Dr. Steichen helped establish.

Indiana Hand to Shoulder Physicians Active at Annual ASSH meeting

The annual ASSH meeting was recently held in Austin, TX with several Indiana Hand to Shoulder physicians presenting during the meeting.

Featured in photo is Jeffrey A. Greenberg at the podium.



Greg A. Merrell, MD Recent Published Work

Dr. Greg A. Merrel has been very active recently.  He has 4 newly published articles as well as leading an international panel of hand surgeons to teach the latest techniques in nerve and tendon transfer at the recent 71st annual meeting of the American Society for Surgery of the Hand in Austin Tx.

Here is a list of the 4 recent published articles from Dr. Merrell:

1. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation.
J Hand Surg Am. 2016 Aug 10.

2. A Multicenter, Prospective, Randomized, Pilot Study of Outcomes for Digital Nerve Repair in the Hand Using Hollow Conduit Compared With Processed Allograft Nerve.
Hand (N Y). 2016 Jun

3. Interobserver Agreement of the Eaton-Glickel Classification for Trapeziometacarpal and Scaphotrapezial Arthrosis.
J Hand Surg Am. 2016 Apr

4. The Effect of Progressive Extensor Retinaculum Excision on Wrist Biomechanics and Bowstringing.
J Hand Surg Am. 2015 Dec

Kathryn M. Peck featured on Publication Cover

Dr. Kathryn M. Peck is featured on the cover of the “Guide for Women in Orthopaedic Surgery” 2nd Edition. The Guide is distributed by the Ruth Jackson Orthopaedic Society. Past fellow Michelle James, MD is also on the cover.

The Ruth Jackson Orthopaedic Society (RJOS) is the oldest surgical women’s organization incorporated in the United States which continues to grow and welcome new members of both genders. RJOS works closely with the AAOS, provides leadership training for orthopaedists, residents and medical students, provides mentoring for medical students, offers award and grants opportunities, courtesy of Zimmer, Inc., and conducts a medical student workshop and much more. Please look around and consider becoming a member today!To find out more please visit

Kathryn M. Peck
Photo Caption for top photo on cover: (L-R) Michelle James, MD, unknown, Lisa Lattanza, MD, unknown, Kathryn Peck, MD, Claire Manske, MD

Preventing and Treating Wrist Tendonitis

Any time you see the suffix itis, it indicates the inflammation of a particular part of the body (think appendicitis, which is inflammation of the appendix, or arthritis, which combines the Greek word for joint–arthro–and itis). And inflammation usually means pain. So in the case of wrist tendonitis, there is pain associated with the inflammation of the tendon or tendons of the wrist, typically due to trauma of some kind or repetitive stress.

In order to treat wrist tendonitis, you must first identify its cause. Once you do, you can then either stop this activity altogether or modify your body mechanics to prevent it from reoccurring. One common example would be switching to an “ergonomic keyboard” to improve your typing posture. This may reduce stress to your wrist tendons and eliminate the inflammation and its associated pain.

Home treatment for wrist tendonitis may include icing the affected area to reduce inflammation, the use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, acetaminophen or naproxen, or exercise to strengthen the affected area to prevent recurrence.

If home treatment doesn’t achieve the desired effect, professional treatment may be required. This may include the use of splints to immobilize the joint, cortisone injections to reduce inflammation, or surgery to permanently repair the joint.

Radial Longitudinal Deficiency

By: Kathryn M. Peck, M.D.

Radial longitudinal deficiency (RLD) is a condition in which the radius bone of the forearm is underdeveloped or absent, resulting in the hand and wrist that angles toward the thumb-side of the forearm. It is a congenital condition (present at birth) in which the radius (the inner bone that connects the elbow to the forearm) did not form correctly in the womb. The radius may be malformed or missing.

radial longitudinal deficiencyIN RADIAL LONGITUDINAL DEFICIENCY:

•    The affected arm is smaller, and stiffness of the fingers and elbow are often present
•    The forearm curves inward because the radius is malformed or missing
•    The thumb is either very small or missing
•    The severity of the condition is different in each child


A baby’s arm forms between week 4 and week 8 of pregnancy, and by week 8, the arms are fully formed but very small.  In some instances, a cause cannot be determined for radial longitudinal deficiency. In other cases, it can be part of a syndrome that affects multiple body parts, including VACTREL, Holt Oram Syndrome, Fanconi’s Anemia, and TAR Syndrome (Thrombocytopenia Absent Radius syndrome).

The heart, kidneys, intestines, blood cells, and limbs form at about the same time. Therefore, problems in these other areas need to be evaluated and often treated before the arm is treated.


Radial longitudinal deficiency can sometimes be seen on ultrasound.  After the baby is born, diagnosis is confirmed through a physical exam and x-rays.

radial longitudinal deficiency


The main goal and benefit of treat is to improve the child’s ability to function with the condition, in addition to improving the appearance of the hand.

Treatment is based on each child because it depends on the complexity of the condition.
•    Stretching
•    Splinting or casting
•    Physical therapy (to help increase strength and function)
•    Prosthetics (in the case of missing parts or bones)
•    Adaptive Aids (to help with daily activities such as getting dressed and personal hygiene)
•    Surgery (to help reposition the wrist, stabilize or create a thumb, or lengthening the shorten arm to help with daily care.

In most cases, surgery is done before the child reaches school age but generally not before 6 months of age. In all cases, the goal of surgery is to repair any associated abnormalities, and improve range of motion and function.

Radial longitudinal deficiency requires a comprehensive approach to the child and family to give the best possible outcome.