We use our hands and wrists for so many things that it can be easy to take them for granted. But when something goes wrong, we realize how indispensable they are to our daily lives.
The Great Basin Orthopaedics (GBO) team is skilled in the care of all hand and upper extremity problems (from the shoulder to the fingertips) — from repairing fractures and other sudden onset injuries to rehabilitation for chronic conditions and full joint reconstruction.
Our team of hand and upper extremities specialists includes skilled surgeon Dr. Timothy Dooley and hand therapists Chelsea Gonzalez and Cindy Hartman. Each month, this team sees about 180 new hand or wrist injuries. Many of these are linked to chronic conditions including carpal tunnel and tendonitis in the hand.
FOOSH, short for “fall on outstretched hand,” injuries are also common, especially in winter. “People slip on the ice and put out their hands to stop the fall, which can result in a fracture,” says Hartman. Great Basin Orthopaedics sees a large volume of wrist and hand injuries from falls because of our location. Northern Nevada is filled with endless outdoor recreational opportunities, many of which lend themselves to hand, wrist and shoulder injury.
Treatment
Oftentimes, it's clear whether there’s a break due to pain or visible cues, but that's not always the case. If you experience significant pain during normal daily activities or tenderness in a specific area, it's wise to seek professional evaluation. Whether it's a break, strain or other condition, seeing a specialist is better than risking further injury.
With the hand and upper extremity injuries that come into the GBO office, our providers will determine if the issue requires surgery. If not, treatment may consist of guided occupational therapy, specialized splinting, a steroid shot or some other form of therapy.
If therapy is prescribed, the hand therapist will create a therapy plan designed to address your specific injury or condition. This could include desensitization, range of motion, pain management and/or therapeutic activities designed to improve function in daily activities or help you return to work after an injury.
When surgery is warranted, Dr. Dooley takes the time to educate our patients on why it’s necessary, as well as the different surgical options, how the procedure will go, expected outcomes and required follow-up care.
Beyond traditional surgery in an operating room, the team at Great Basin Orthopaedics can also perform minimally invasive in-office procedures that are highly effective for some conditions. We offer Xiaflex injections for treatment of Dupuytren's contracture — an abnormal thickening of the fascia in the hand that causes the fingers to curl up. If a provider feels a patient can benefit from a custom orthotic (splint), one will be custom made to be used for positioning, protection or mobilization. For example, three days after the Xiaflex injection, the patient will return for manipulation to straighten their fingers. Afterward, the custom orthotic can be to hold the fingers in a straightened position for several weeks so they don’t flex back down.
For carpal tunnel, Dr. Dooley can perform a minimally invasive endoscopic release with one small incision and the use of a tiny camera to guide the cutting of the ligament. This results in less pain and a faster recovery than traditional carpal tunnel release surgery, with most people returning to their normal activities within a few days.
Many hand procedures such as carpal tunnel release, tendon repair and removal of masses can now be performed under local anesthesia alone, avoiding the use of sedation or general anesthesia. The technique — known as wide-awake local anesthesia, no tourniquet (WALANT) — can be performed in the surgeon’s office and Dr. Dooley has specific training in these techniques. Allowing the patient to be awake during surgery allows the surgeon to evaluate the strength of repair by having them move the tendons. Evaluating the strength of repair offers a better idea of how to guide postoperative therapy. Also, when WALANT surgeries are performed, they can save the patient a significant amount of money because the procedure can often be performed in the office.
Prevention
While Great Basin Orthopaedics is able to help you get back to your daily activities after a hand or upper extremity injury including FOOSH injuries, the easier and less painful solution is to avoid injuring yourself in the first place.
Read: Avoiding Injury in the Office
When we fall, our natural inclination is to put our hands out to avoid injuring our head and other parts of the body. If you’re participating in an activity where your wrists are vulnerable to falls (snowboarding, mountain biking or ladder work) or you perform frequent repetitive motion with your wrists (stocking shelves, typing, playing video games), wrist braces are recommended to help prevent injury by providing additional support. Hartman says it also helps to keep your arms close to your body when using a screwdriver or other small hand tools. “That way your larger muscles are doing more of the work than your wrists.”
If you are experiencing hand or wrist pain, or if you have sustained a hand injury from falling, give us a call at 775.786.1600. Our team of hand experts will fully assess you to determine the best treatment to help you get back to doing the activities you love, pain free.
Continuity of Care
While GBO now offers patients physical therapy and orthopaedic services in the same building, Dr. Lilyquist will refer his patients to whichever physical therapy office they choose. However, if you don’t already have a preferred therapist, there are advantages to working with one who shares an office with your surgeon. Dr. Lilyquist has a close working relationship with Hartman that enables them to integrate surgical care and recovery. “We meet every week to discuss patients,” he says. “It makes it easier to answer questions and make adjustments to treatment plans when necessary.”
If you have hand or wrist pain, give us a call at 775-786-1600. We will fully assess you to determine whether you need physical therapy, surgery or something else to get back to doing the activities you love. Pain-free.