HAND, WRIST & ELBOW CARE

The human hand and wrist are wonderfully elaborate and complex.  Because of this complexity, many types of injuries can occur most of which can be managed without surgery.

Some of the most common problems that we manage are listed below:

Dr. Mark Perlmutter.jpg

Dr. Mark N. Perlmutter

Director of Hand, Wrist & Elbow Services

While this list is only a few of the injuries to the hand or wrist that may need surgery, all of these should be seen by a medical professional. The goal of surgery is to restore function, decrease the chance of re-injury, and minimize pain.

ARTHRITIS CARE

Arthritis is joint pain that can occur at any age. Symptoms may include swelling, pain, and stiffness of the joints. They can be anywhere from mild to severe, while the symptoms may stay the same for a couple of years. Arthritis pain may also progress rapidly. There are many different body areas where arthritis can occur. Once your arthritis is clearly diagnosed, the Carolina Regional Orthopedics’ physician who is specifically trained in that area will treat you. This condition can make simple everyday activities difficult to accomplish. The fundamental goal of arthritis care is to help reduce pain, improve joint function, and restore full range of motion. Arthritis care encourages lifestyle changes including exercise, physical therapy, and dietary changes to accomplish its goals.

 

CANCER TREATMENT

Bone cancer is when unusual cells grow out of control in your bone. It destroys normal bone tissue. It may start in your bone or spread there from other parts of your body (called metastasis). Bone cancer is rare. Most bone tumors are benign, which means they aren’t cancer and don’t spread to other areas of your body. But they may still weaken your bones and lead to broken bones or other problems.

There are a few common types of benign bone tumors:

  • Osteochondroma is the most common. It often happens in people under age 20.

  • Giant cell tumor is usually in your leg. In rare cases, these can also be cancerous.

  • Osteoid osteoma often happens in long bones, usually in your early 20s.

  • Osteoblastoma is a rare tumor that grows in your spine and long bones, mostly in young adults.

  • Enchondroma usually appears in bones of your hands and feet. It often has no symptoms. It’s the most common type of hand tumor.

 
 

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist. A narrow, rigid passageway of ligament and bones at the base of the hand—houses the median nerve and the tendons that bend the fingers. The median nerve provides feeling to the palm side of the thumb and to the index, middle, and part of the ring fingers (although not the little finger). It also controls some small muscles at the base of the thumb.

Sometimes, thickening from the lining of irritated tendons or other swelling narrows the tunnel and compresses the median nerve. The result may be numbness, weakness, or sometimes pain in the hand and wrist (some people may feel pain in the forearm and arm). CTS is the most common and widely known of the entrapment neuropathies, in which one of the body’s peripheral nerves is pressed on or squeezed.

At the workplace, workers can do on-the-job conditioning, perform stretching exercises, take frequent rest breaks, and use correct posture and wrist position. Wearing fingerless gloves can help keep hands warm and flexible. Workstations, tools, tool handles, and tasks can be redesigned to enable the worker’s wrist to maintain a natural position during work. Jobs can be rotated among workers. Employers can develop programs in ergonomics, the process of adapting workplace conditions and job demands to the capabilities of workers. However, research has not conclusively shown that these workplace changes prevent the occurrence of carpal tunnel syndrome.

FRACTURE TREATMENT

A fracture is when a bone becomes either partially or completely broken, whether it is crosswise, length-wise, or in multiple places. The bone can break because of a fall, an accident, overuse, etc. Treatment depends on the severity of the break. At Carolina Regional Orthopedics our physicians will discuss with you how the injury occurred and your medical history. Our physicians will then perform an examination to assess the extent of your injury, including an x-ray to help provide a better understanding of the injury. Once the physician has reviewed all the factors stated above, he will choose the treatment best suited for your needs. These treatments may include cast immobilization, functional cast or brace, traction, or surgery. Cast immobilization is a plaster or fiberglass cast to keep the broken ends in the correct position while they heal. This is a very common treatment for bone fractures. A functional cast or brace is a brace that allows for limited controlled movement. Traction is when the bones are aligned by a gentle pulling action to help stabilize and realign a bone fracture. If surgery is recommended by the physician, details will be discussed in-depth with each patient before the surgery is performed.

 

MICROVASCULAR/

REPLANTATION SURGERY

Microvascular surgery is a broad term that refers to surgery for patients who have suffered from a detached body part. During the surgery, the severed body part is reattached and with extensive therapy, it may be possible to regain the functionality of the body part. In the case of an emergency, amputation makes certain to stabilize the patient, apply steady pressure, and elevate the body part. Then, collect all the severed tissue wrapping it in saline-soaked gauze and placing it in a plastic bag on top of the ice. The success of the surgery may depend on the amount of original tissue the surgeon is able to use.

 

PEDIATRIC ORTHOPEDICS

A child's musculoskeletal problems are different from those of an adult. Because children are still growing, the body's response to injuries, infections, and deformities may be quite different than what would be seen in a full-grown person.

Sometimes, what is thought to be a problem in a child is just a variation of growth that will resolve with time. A good example of this is intoeing in a toddler. Some of the problems children have with their bones and joints that are due to growth do not even occur in adults. In addition, the evaluation and treatment of a child are usually quite different than for an adult -- even for the same problem.

Children with complex pediatric problems are best managed by a medical-surgical team approach. Pediatric orthopedic surgeons diagnose, treat, and manage children's musculoskeletal problems, such as:

  • Limb and spine deformities noted at birth or later in life (clubfoot, scoliosis, limb length differences)

  • Gait abnormalities (limping)

  • Broken Bone

  • Bone or joint infections and tumors 

 

SPRAINS & STRAINS

A sprain and a strain are very common injuries that can be confused as the same thing. However, a sprain occurs in a ligament, whereas a strain occurs in a muscle or tendon. A sprain is when the tissue that connects two bones together is stretched or torn. A strain occurs when the tissue that connects the muscle to bone is stretched or torn. Symptoms for both can include limited movement of the joint that is affected, pain, and swelling. A symptom specifically for a sprain includes a “pop” in the joint at the time of the injury, while a specific symptom for a strain may include muscle spasms. If the injury becomes more serious you may not be able to walk more than four steps without considerable pain or move the affected joint. You may also have pain that is directly over the injured area or has numbness in any area of the injured area. In these cases, it is best to seek a professional orthopedic opinion. For mild sprains or strains, successful at-home treatment can include rest, ice, compression, and elevation.

 

TENDON & LIGAMENT INJURIES

Tendon and ligaments are both connective tissue; however, tendons connect muscle to bone, while ligaments connect bone to bone. They are both injured when the soft tissue that connects the muscles and joints tear or rupture. This may happen due to a sudden impact on the joint, quickly stopping or starting, or an abrupt movement to the joint. A tendon or ligament injury can happen to any joint in the body, but the knees are the most common area. Symptoms for an injured tendon or ligament include pain, swelling, a popping or clicking sensation, or an inability to straighten the knee. If you injure a tendon or ligament you should seek immediate medical attention. The physician will collect your medical history, perform a physical exam, and ask questions regarding the injury. From there, the physician will diagnose the injury and provide you with the treatment needed. These treatments may include wearing a brace, physical therapy, rest, ice, compression, elevation, and surgery.

 

UPPER EXTREMITY JOINT REPLACEMENT

Joint replacement of the hand and wrist are very similar to a knee or hip replacement. The damaged joints are replaced by a prosthetic joint that can be made of Silicone, Polyethylene, Titanium, or Pyrocarbon. It is less common for the joints to be replaced in the hands or wrist, because the bone structure of the hand is small and complex, making the surgery more challenging. Since joint replacement is a major surgery, some things to consider before deciding on the surgery are the recovery time, age, pain, and disability. Surgery may be a good idea if you cannot complete regular daily tasks without assistance, have significant pain every day, pain does not go away when you rest, non-surgical approaches do not provide relief, or pain keeps you awake at night.

 

WORK-RELATED INJURIES

Each state has their own requirements for Workers’ Compensation that is regulated by the state's Industrial Commission. There is a simple five-step process specifically for North Carolina. The first step begins with seeking out appropriate medical treatment. If your employer has a health care provider on-site and is compatible with their instructions, then the on-site health provider is the appropriate medical treatment to seek. If your employer does not have an on-site health provider, then you may be instructed to visit a designated health care office. It must be established that the injury was related to your work and your employer’s name must be provided. This will allow your health care provider to bill the treatment as a workers’ compensation claim. The main goal of the Workers’ Compensation in North Carolina is to ensure you have the medical care needed to restore your health and ability to work as you had before the accident.