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Kevin R. Knox, M.D. Provides Medical Expertise in Kenya

Kevin R. Knox, M.D.

Kevin R. Knox, M.D.

Kevin R. Knox, M.D. was in Kenya this week as part of the partnership between Indiana University in the United States and Moi University in Kenya. Dr. Knox will be providing educational expertise as well as medical care.

The partnership between Indiana University in the United States and Moi University in Kenya represents a unique model. Since 1989, Indiana University School of Medicine and Moi University School of Medicine (MUSM) in Eldoret, Kenya have collaborated to promote collegial relationships between American and Kenyan medical doctors, scientists, and students, and to develop leaders in hea

lth care in Kenya and the United States. The mission of this new partnership was to develop leaders in health for the United States and Africa, foster the values of the medical profession, and promote health and well-being in both countries.

This medical school-medical school partnership is built on the premise that individual and institutional good derives from the integrity of individual counterpart relationships. The IUSM-MUSM partnership emphasizes bilateral exchange, mutual benefit, and long-term commitment. The partnership is departmentally based and integrated across multiple disciplines and throughout all levels of both institutions from student body to Department Heads and Deans. Funding comes from multiple sources including philanthropic support.

Gregory A. Merrell, MD publishes new article in the Journal of Hand Surgery

Gregory A. Merrell, MD had an article titled “Suture constructs for rehabilitation using early active motion after tendon transfer surgery” in the Journal of Hand Surgery (European Volume). The purpose of this study was to better define an ideal tendon transfer suture construct to allow for early active range of motion.

Gregory Merrell article

Work Comp Seminar Held at IHTSC

Dr. Greg Merrell and our team at the Indiana Hand to Shoulder Center held another successful Work Comp educational luncheon last week, Dr. Merrell’s presentation and Q&A on Causation in Work Related Injuries was another step forward in providing excellence in patient care.


Kevin R. Knox, M.D. in La Paz, Bolivia volunteering with The Touching Hands Project

Kevin R. Knox, M.D. is in La Paz, Bolivia this week volunteering with The Touching Hands Project.

The Touching Hands Project – WHAT WE DO

Each THP medical team is comprised of hand surgeons, nurses, anesthesiologists, and hand therapists. The teams travel around the world to poor countries such as Haiti, Ethiopia and Honduras to treat and evaluate patients for hand and/or arm conditions, deformities and injuries. During each 1- or 2-week mission, the THP team will see and treat around 100 patients!

Many of the patients treated are victims of horrific violence that takes place in these struggling countries. The people in the communities we visit have limited access to healthcare and sometimes have no hand surgeons in the entire country. Our teams are giving children an opportunity to grow up and function as a normal child and are giving adults the opportunity to use their hands again, which can be a matter of survival in countries where manual labor dominates the work force.


The Touching Hands Project (THP) provides free hand surgery and hand therapy to adults and children in underserved communities around the world. From children with deformities to adults with chronic pain or victims of unspeakable violence, the THP volunteers work to better the lives of patients who desperately need hand care. We send teams of hand surgeons, anesthesiologists, nurses and hand therapists to countries that have little access to medical care. Our work allows these patients to use their hands again, whether it’s to hold their child, return to work, eat a meal, or put on their shoes. Your support, even in the smallest amount, can change a life.

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.



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.