2015 update on hand/ wrist disorders - boston college · 2015 update on hand/ wrist disorders...
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22nd Annual Northeast Regional Nurse Practitioner Conference – May 6-8, 2015
2015 Update on Hand/Wrist DisordersAnthony Mollano, MD
D I S C L O S U R E S
• 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.
A C C R E D I TAT I O N
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.
22nd Annual Northeast Regional Nurse Practitioner Conference – May 6-8, 2015
S E S S I O N O B J E C T I V E S
• 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.
Hand/Elbow Musculoskeletal “2015 Update”- Injuries and Conditions- Fingertip to the Elbow
Anthony Mollano MD Hand/Wrist/Elbow Surgery
Concord, NH
ACUTE HAND TENDON AND NERVE INJURIES
50 YEAR-OLD CUT FINGERS WHILE SLICING A BAGEL AT HOME.
FINGER TENDON AND NERVE LACERATIONS
35 year-old firefighter, had 3 week old laceration from a utility knife, reports numbness.
Nerve not repairable by routine direct microsurgery repair
FINGER DIGITAL NERVE LACERATION
Nerve regeneration is slow: 1mm/day ; 1 inch/month; Up to 2 yrs in some cases.
Bovine collagen conduit repairs, Good outcomes, multiple studies.
FINGER DIGITAL NERVE LACERATION
WRIST COLLES RADIUS 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.
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.
COLLES FRACTURE
WRIST SCAPHOID FRACTURE
21yo NEC college student, hurt wrist surfing on spring break in NC
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
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
SCAPHOID FRACTURE
Wrist Dislocations
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
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
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
WRIST ARTHRITIS
CTS
WHO GETS CARPAL TUNNEL SYNDROME?
CTS
SURGERY (mini-open, 5min, local anesthesia) CTS
THUMB BASAL JOINT DEGENERATIVE ARTHRITIS
65 year-old active retired judge with thumb pinch weakness, pain, and deformity. What’s is RX?
THUMB CMC BASAL JOINT ARTHRITIS
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.
THUMB CMC BASAL JOINT ARTHRITIS
THUMB CMC BASAL JOINT ARTHRITIS
SEVERE SPORTS THUMB LIGAMENT TEARS
i.e. “the gamekeep injury”
OR
the “ACL” of the hand
16 yo bishop brady thumb MP hyperextension injury stopping hard shot
THUMB MP LIGAMENT TEAR
THUMB MP LIGAMENT TEAR
CUBITAL TUNNEL SYNDROME
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.
“Ulnar nerve transpotion” = NERVE is decompressed and transposition
ELBOW BICEPS AND TRICEPS TENDON
INJURIES
42 yo CJ state trooper tore elbow biceps moving furniture felt a large “POP” with elbow swelling
BICEPS DISTAL RUPTURE
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.
ELBOW DISTAL BICEPS REPAIR
ELBOW FRACTURES
STABLE RADIAL HEAD FXS- COMMON RX- NONOP WITH ROM/PT. IF FX WORSE- SURGERY WITH REPLACEMENT, OR RARELY EXCISION.
Thanks