Are the 'simple' diagnoses in hand surgery really that simple?

Chuck and Chris discuss "simple" diagnoses that may be overlooked in residency and fellowship training.  Diagnoses like mucous cysts, ganglion cysts, and carpal boss.  We definitely do not agree on management on many of these.  Join us to hear our opinions and always feel free to share yours at handpocast@gmail.com

Also, we are in need of a podcast intern!  We would appreciate any referrals!

See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.

The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.

As always, thanks to @iampetermartin for the amazing introduction and concluding music.

For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

Transcript

Quick recap

Charles and Christopher discussed the results of their survey and planned upcoming podcast content focused on practical treatment approaches for various hand conditions. They announced contest winners of coffee mugs and backpacks from survey respondents and shared personal updates including Christopher's weekend plans and advice for transitioning from fellowship to practice. The conversation concluded with detailed discussions about treating various hand conditions like ganglion cysts and tennis elbow, emphasizing the importance of patient-specific treatment approaches and continuous learning in surgical practice.

Summary

Survey Results and Treatment Approaches

Charles and Christopher discussed the results of their recent survey and planned to focus on practical treatment approaches for various diagnoses in their upcoming podcast. They also addressed a listener's question about removing the pisiform bone, with Charles explaining his approach to the procedure. The conversation highlighted the importance of learning from audience feedback and applying those lessons to improve their podcast content.

Survey Contest Winners Announced

Christopher and Charles announced the winners of a survey contest, selecting two people to receive coveted Upper Hand coffee mugs and two others to receive limited edition backpacks. Christopher shared plans to hike in Carbondale, Illinois, with his family over the weekend, including activities like archery and fishing. The winners were selected randomly from the 43 survey respondents who provided email addresses.

Fellowship to Practice Transition Challenges

Christopher and Charles discussed the challenges of transitioning from fellowship to practice, emphasizing the importance of setting personal and professional goals before starting a new position. They advised incoming fellows to enjoy their final weeks of fellowship without focusing on future practice, as there will be ample time to prepare and adapt once they begin. Charles shared Dan will miss him next year  in his first job, highlighting the difficulty of lacking an experienced assistant. 

Balanced Scheduling and Fellowship Advice

Charles and Christopher discussed scheduling strategies, with Christopher sharing his approach of being one-third over-scheduled, one-third appropriately scheduled, and one-third under-scheduled to maintain a balanced workload. Charles advised that as practitioners mature, the focus should be on completing cases by the end of the day, while for new fellows, it's important to approach the experience with a positive attitude and willingness to learn, as it serves as a foundation for their careers. Christopher also recommended setting a routine during fellowship, including reading one article per day, and adapting to a morning schedule to accommodate energy levels and personal life.

Surgeon's Mindset and Continuous Learning

Charles and Christopher discussed the challenges and rewards of being a surgeon, emphasizing the importance of humility, reflection, and continuous learning. They highlighted the need for surgeons to process setbacks effectively while maintaining focus and attention during surgeries. Charles advised incoming fellows to be open-minded and receptive to different perspectives, while Christopher encouraged them to remain eager to learn and improve. They also briefly touched on the value of reflecting on complications to enhance surgical practice.

Hand Conditions and Treatment Approaches

Charles and Christopher discussed the upcoming course on treating spasticity hosted by Checkpoint Surgical in Las Vegas. They then focused on practical treatment approaches for various hand conditions, including carpal boss, retinacular cysts, and others. Charles shared his experience with treating carpal boss, describing it as an enlargement at the base of the third metacarpal and his approach to both conservative and surgical treatments. Christopher and Charles agreed that their experiences with these conditions varied, possibly due to differences in patient populations.

Retinacular Cyst Management Discussion

Charles and Christopher discussed the management of retinacular cysts, with Christopher explaining that these cysts, associated with the flexor sheath, are typically found between the A1 pulley and the palmar digital crease. He advised counseling patients not to intervene unless the cyst is painful, at which point aspiration or removal could be considered. Charles shared his approach of using a 25-gauge needle to inject lidocaine and puncture the cyst, finding it effective for most cases. They agreed on the importance of considering patient-specific factors when deciding on treatment, with Christopher emphasizing the need for ultrasound-guided aspiration when necessary.

Ganglion Cyst Management Debate

Charles and Christopher discussed the management of ganglion cysts, particularly occult ganglions. Charles explained his approach to diagnosing and treating ganglion cysts, including the use of ultrasound and MRI. He emphasized that the decision to proceed with surgery should be made by the patient, not the surgeon. Christopher expressed skepticism about surgery for occult ganglion cysts, preferring image-guided aspiration or steroid injections. They also briefly touched on other conditions like tennis elbow and mucus cysts.

Ganglion Cysts and Tennis Elbow

Charles and Christopher discussed their approaches to treating ganglion cysts and tennis elbow. They agreed that aspiration or injection is generally not recommended due to infection risks, with surgical removal being a last resort. Christopher emphasized counseling patients against any intervention unless there are signs of infection. They also briefly touched on the potential for regenerative medicine topics in future episodes.