2015 Update on Hand/ Wrist Disorders. Anthony Mollano, MD
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1 2015 Update on Hand/ Wrist Disorders Anthony Mollano, MD 22nd Annual Northeast Regional Nurse Practitioner Conference May 6-8, 2015
2 DISCLOSURES There has been no commercial support or sponsorship for this program. The planners and presenters have declared that no conflicts of interest exist. The program co-sponsors do not endorse any products in conjunction with any educational activity.
3 ACCREDITATION Boston College Connell School of Nursing Continuing Education Program is accredited as a provider of continuing nursing education by the American Nurses Association Massachusetts, an accredited approver by the American Nurses Credentialing Center s Commission on Accreditation.
4 SESSION OBJECTIVES Describe treatment options for thumb basal joint arthritis. Discuss workup and treatment options for wrist injuries and arthritis. Discuss workup and treatment options for thumb sprains and ligament injuries. Identify treatment options for carpal tunnel syndrome. 22nd Annual Northeast Regional Nurse Practitioner Conference May 6-8, 2015
5 Hand/Elbow Musculoskeletal 2015 Update - Injuries and Conditions- Fingertip to the Elbow Anthony Mollano MD Hand/Wrist/Elbow Surgery Concord, NH
6
7 ACUTE HAND TENDON AND NERVE INJURIES
8 50 YEAR-OLD CUT FINGERS WHILE SLICING A BAGEL AT HOME.
9 FINGER TENDON AND NERVE LACERATIONS
10 FINGER DIGITAL NERVE LACERATION 35 year-old firefighter, had 3 week old laceration from a utility knife, reports numbness. Nerve not repairable by routine direct microsurgery repair
11 FINGER DIGITAL NERVE LACERATION Bovine collagen conduit repairs, Good outcomes, multiple studies. Nerve regeneration is slow: 1mm/day ; 1 inch/month; Up to 2 yrs in some cases.
12 WRIST COLLES RADIUS FRACTURE
13 COLLES FRACTURE 25 yo Concord pro rock climber, w/ acute deformed wrist injury, tripped down stairs texting! Same day surgery on a Monday b/c of acute CTS too.
14 COLLES FRACTURE Injury Sunday. Surgery same day seen on Monday. Outpatient surgery, 1hr; Open repair/reduction volar plate and fixed angle screws; Immediate use of hand for light ADL. At 2 m, healed, done splinting. Now 3 months after, already rock climbing. Strength and ROM improves for up to 1 yr.
15 WRIST SCAPHOID FRACTURE
16 SCAPHOID FRACTURE 21yo NEC college student, hurt wrist surfing on spring break in NC
17 SCAPHOID FRACTURE -Outpatient surgery; 30min -Mini-incision screw repair to compress one fragment into other; provides stability and compression -Early rehabilitation allowed; Removable splint used for protection
18 SCAPHOID FRACTURE Immediate ROM and light hand use for ADLs x 6wks w/ splint for protection; At 3 months, had full ROM and able to lifeguard that summer
19 Wrist Dislocations
20 Severe wrist dislocation 17yo merrimack valley quarterback, playing on a Sunday. Monday had urgent same day surgery after visit b/c of acute CTS. Pins out after 8 wks, then therapy and weight lifting all winter. Will be ready for UNH football camp this summer
21 Wrist Arthritis
22 WRIST ARTHRITIS 52yo, NH college golf coach and semi-pro golfer; severe wrist pain; can no longer golf nor write; limited ROM; poor strength; tried injections and splints for years
23 WRIST ARTHRITIS Proximal row carpectomy surgery; outpatient, 1 hr; casted 4 wks, then formal therapy 1-2 m Outcome at 3 months: satisfied; pain, function, and strength much improved; Some stiffness remains; 1-2 yrs for max conditioning and strength improvement
24 CTS
25
26 WHO GETS CARPAL TUNNEL SYNDROME?
27 CTS
28 CTS SURGERY (mini-open, 5min, local anesthesia)
29 THUMB BASAL JOINT DEGENERATIVE ARTHRITIS
30 THUMB CMC BASAL JOINT ARTHRITIS 65 year-old active retired judge with thumb pinch weakness, pain, and deformity. What s is RX?
31 THUMB CMC BASAL JOINT ARTHRITIS
32 THUMB CMC BASAL JOINT ARTHRITIS If practical treatment fails and arthritis join pain worsens, outpatient joint arthroplasty/replacement provides: great pain relief and much improved function. 1hr surgery. Cast 1 month, then brace 1 month, then therapy. In WC cases, MMI 1 year, +PIR.
33 THUMB CMC BASAL JOINT ARTHRITIS
34 SEVERE SPORTS THUMB LIGAMENT TEARS i.e. the gamekeep injury OR the ACL of the hand
35 THUMB MP LIGAMENT TEAR 16 yo bishop brady thumb MP hyperextension injury stopping hard shot
36 THUMB MP LIGAMENT TEAR
37 CUBITAL TUNNEL SYNDROME
38 Cubital Tunnel Syndrome 18 yo NC bow high baseball pitcher injured tommy john elbow ligament in elbow in spring, and stretched ulnar nerve. Ligament healed, but nerve numbness worsened with constant numbness. Old patient of mine from hockey hand hamate hook nonunion surgery when 14.
39 Ulnar nerve transpotion = NERVE is decompressed and transposition
40 ELBOW BICEPS AND TRICEPS TENDON INJURIES
41 BICEPS DISTAL RUPTURE 42 yo CJ state trooper tore elbow biceps moving furniture felt a large POP with elbow swelling
42 ELBOW DISTAL BICEPS REPAIR Super biceps repair. 1hr surgery, after one week, early progressive therapy done. Back to work light duty after 1 week, full duty after 2 months, and arm strength after 6 months.
43 ELBOW FRACTURES
44 STABLE RADIAL HEAD FXS- COMMON RX- NONOP WITH ROM/PT. IF FX WORSE- SURGERY WITH REPLACEMENT, OR RARELY EXCISION.
45 Thanks
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