Category - upper extremity

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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.

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.

 

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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

CAUSES OF RADIAL LONGITUDINAL DEFICIENCY:

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.

DIAGNOSIS:

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

TREATMENT:

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.

2016-2017 Indiana Hand to Shoulder Center Fellowship Class

Please welcome the new class of fellows to the Indiana Hand to Shoulder Center.

Jue Cao, M.D. – University of Colorado
Alexander D. Choo, M.D. – University of California
Megan S. Crosmer, M.D. – Duke University
Paul J. Nielsen, M.D. – University of Nebraska
Amar A. Patel, M.D. – Jackson Memorial Hospital
Brandon S. Smetana, M.D. – University of North Carolina
Shannon E.Yehyawi, M.D. – University of Iowa

 

indiana hand to shoulder center fellowship

2015-2016 Fellows Complete a year of specialized training in the Upper Extremity

Congratulations to the 2015-2016 Indiana Hand to Shoulder Center fellows as they end their year fellowship in specialized training of the upper extremity. Good luck at your future practices.

–Sam Abrams – Carolina Hand & Sports Medicine, Asheville, NC
–Mike Fitzgerald – Syracuse Orthopaedic Specialists, Syracuse, NY
–Ty Garon – Baton Rouge, LA
–Levi Hinkelman – Grand Rapids, MI
–Jeff Kutsikovich – Vanderbilt Bone and Joint Clinic, Franklin, TN
–Scott Rogers – Northeast Orthopedics and Sports Medicine, Kalispell, MT
–Justin Zumsteg – Orlando Regional Medical Center, Orlando, FL

 

2015 indiana hand to shoulder fellowship program

Don’t Let Your Laptop Ruin Your Posture

fb_laptop_blogLaptop computers are everywhere. They’re portable and lightweight – so much so, that many people use them throughout the day, be it at work, at home, or at the local coffee shop. But laptop use can lead to posture problems, if you’re not careful.

The very thing that makes a laptop computer so popular – its convenient all-in-one design – also makes it a potential hazard. Unlike a desktop computer, a laptop’s keyboard and screen are attached to each other. Ergonomically speaking, an optimal computer setup would have your monitor in your direct eye line, your keyboard near your waist, and your forearms at a 90-degree angle to your upper arms. But due to its attached screen, this is not possible with a laptop.

With a laptop, you make sacrifices. Your typing position may be too high, which can cause issues such as carpal tunnel syndrome. And your monitor position may be too low, which can cause neck- and shoulder-strain issues.

To minimize laptop-related issues, you should consider the following suggestions:

  • Purchase a docking station and external monitor for your laptop. Not only will this monitor be larger and easier to read, it can be adjusted to a proper ergonomic level.
  • Consider a second keyboard. A second keyboard can be placed in a keyboard tray under your desk that can help you maintain an optimal 90-degree elbow angle.
  • Try to find a chair that can be adjusted to provide the best compromise between monitor angle and keyboard position.
  • If you are unable to work at an ergonomic laptop station, make sure you take frequent breaks—usually every 20 minutes or so. This will help minimize joint and muscle strain.
  • Be aware of warning signs. If you notice tingling, numbness, or pain, take a break. If it persists, see a doctor.
  • And, finally, never use a laptop on your lap. Not only does this force you to look down at your monitor at a very awkward angle, it also creates the risk of heat damage. Modern portable computers have become thinner and smaller as they’ve become more powerful. This means they generate more heat with less space to dissipate it. Consequently, laptops get extremely hot, especially when used for intensive tasks or for long periods of time. In fact, this risk of burning your skin is why laptops are no longer called laptops but are instead referred to as notebook computers by the computer industry.

For more information on laptop ergonomics visit our workstation tips page.

Please Welcome our newest Physician, Reed W. Hoyer, MD

Reed W. Hoyer, Indiana Hand to Shoulder CenterDr. Hoyer attended Wabash College, where he played varsity basketball and graduated with honors. After completion of his undergraduate education, he was awarded his medical degree from Indiana University School of Medicine.

He went on to residency training in orthopedic surgery at Tufts Medical Center in Boston, MA. He was elected to attend the AOA residence leadership conference and named outstanding chief resident. He completed his post-graduate training with a fellowship in surgery of the hand and upper extremity at Tufts Medical Center and the prestigious New England Baptist Hospital.

Dr. Hoyer’s clinical expertise encompasses all areas of the adult upper extremity, including traumatic injuries, degenerative conditions, sports injuries, and peripheral nerve disorders. He is also well versed in traumatic injuries to the pediatric upper extremity. He has a special interest in elbow pathology, including fractures, instability, elbow arthroscopy, and elbow replacement. Additionally, he is interested in primary and revision total joint arthroplasty of the shoulder.

Dr. Hoyer is a candidate member of the American Academy of Orthopedic Surgeons and the American Society for Surgery of the Hand. He is also an Emerging Leader in the American Orthopedic Association, and he is a member of the AMA and the Indiana State Medical Association.

Dr. Hoyer will see patients at the following locations: Indianapolis-Downtown, Indianapolis-Northside and Greenwood.