Show of hands

We use our hands and wrists for so many things it can be easy to take them for granted. Until, of course, something goes wrong. That’s when we realize how very 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.

GBO surgeon Dr. Michael Lilyquist and occupational therapist Cindy Hartman who both specialize in the care of the hand and upper extremities say they see about 250 new hand or wrist injuries every month. Many of those are carpal tunnel, tendonitis, or chronic conditions related to common repetitive activities, like typing or lifting.

FOOSH (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. Or worse,” Hartman says.

It’s possible GBO sees more hand and wrist injuries than orthopaedic practices in other regions because of where we’re located. Northern Nevada is filled with endless outdoor recreational opportunities, many of which lend themselves to hand, wrist and shoulder injury. “We see a lot of hand and wrist fractures during skiing and mountain biking season,” Dr. Lilyquist says. “So pretty much year-round.”

Treatment

Sometimes the break is obvious due to extreme discomfort and visual cues, but this is not always the case. “If you have a lot of pain when doing simple, everyday activities, or there’s tenderness in a particular area, you should get it checked out,” Dr. Lilyquist says. If ice and rest don’t help, there’s likely something else going on. Whether you suspect a break or a severe strain, it’s better to get evaluated by a professional than to tough it out.

With the hand and upper extremity injuries that come into the GBO office, Dr. Lilyquist says they will always try a non-operative approach first. This might consist of guided occupational therapy, specialized splinting, a steroid shot or some other form of therapy.

If therapy is prescribed, Hartman will create a therapy plan designed to address the patient’s specific injury. This could include desensitization, range of motion, pain management and/or therapeutic activities designed to improve function in daily activities or return to work after an injury.

When surgery is warranted, the GBO team takes the time to educate its patients on why it’s necessary, different surgical options, how the procedure will go, expected outcome and required follow-up care.

The Conventus Cage is a 3-D surgical procedure, which in Northern Nevada is unique to Dr. Lilyquist and GBO. “It’s a minimally invasive approach, where the cage goes inside of the bone, replacing the typical plate and screws,” Lilyquist says. “The main advantage is that it doesn’t require the hand or wrist to be immobilized for six weeks after surgery. The soft dressings come off after two days and you can usually start therapy right away.” The Conventus Cage can even help patients avoid joint replacement for wrist, elbow and shoulder fractures.

Dr. Lilyquist says the main challenge with this system is that people start feeling better so quickly they want to jump right back into their activities. “They feel better, but it still takes six weeks for a bone to heal,” he says.

Beyond traditional surgery in an operating room, Dr. Lilyquist can also perform minimally invasive in-office procedures that are highly effective for some conditions. He does 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 Dr. Lilyquist feels a patient can benefit from a custom orthotic (splint), Hartman will custom fabricate it to be used for positioning, protection or even mobilization. For example, three days after the Xiaflex injection, the patient will return to Dr. Lilyquist for a 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. Lilyquist 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. Dr. Lilyquist says most people are back to work and 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. Lilyquist has specific training in these techniques.

“Allowing the patient to be awake during surgery allows me to evaluate the strength of repair by having them move the tendon we’re working on. And by evaluating the strength of repair, we have a better idea of how to guide their postoperative therapy,” Dr. Lilyquist explains. “When WALANT surgeries are performed, they can also save the patient a significant amount of money because the procedure can often be performed in the office.”

Prevention

While GBO is ready and able to help you get back out there after a hand or upper extremity injury, 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 do a lot of repetitive motion with your wrists (stocking shelves, typing, playing video games)‚ Dr. Lilyquist recommends wearing wrist braces, which can 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.” 

“Of course, understanding and knowing how to fall and roll to cushion the blow is also helpful,” Dr. Lilyquist adds. Training through gymnastics or martial arts classes will provide knowledge on how to fall and distribute the energy that eventually comes from hitting the ground.

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.