Challenges with "Simple" Procedures in Hand Surgery

Chuck and Chris review common, "straightforward" surgeries in hand surgery and what might go wrong.  We specifically discuss trigger finger release, dequervains release, ganglion excision and carpal tunnel release.  We share our thoughts and hope for listener feedback.

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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.

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Transcript

Summary

Personal and Academic Updates

Charles and Christopher discussed their recent experiences with winter weather in St. Louis, with Charles noting that the city received significant snowfall. They briefly touched on the challenges of dealing with snow and ice, particularly for those not accustomed to such weather. The conversation then shifted to Charles's recent academic trip to Philadelphia and the University of Pennsylvania, where he gave presentations on ulnar wrist and TFCC surgery, as well as a talk on impact and influential readings. 

Orthopedic Surgery Challenges and Alternatives

Charles and Christopher discussed challenges in orthopedic surgery, focusing on a case of recurrent trigger finger that required a second surgery. They explored the role of steroid injections as a potential alternative to surgery, noting that patient preferences and experiences with previous treatments influence their decision-making. The conversation also touched on the complexities of healthcare systems and the importance of clear communication with patients. 

De Quervain's Disease Surgical Techniques

Charles and Christopher discussed surgical techniques for treating de Quervain's disease. They agreed on the importance of releasing the first compartment as dorsally as possible to prevent volar subluxation of tendons. Christopher shared that he typically uses 10cc of local anesthetic and makes an oblique incision proximal to the radial styloid. They also discussed the rarity of separate compartments for the EPB muscle, with Christopher noting that he looks for the EPB muscle belly to confirm its presence.

Hand Surgery Techniques and Protocols

Charles and Christopher discussed surgical techniques and post-operative protocols for various hand procedures, including ganglion cysts, carpal tunnel releases, and volar ganglions. They shared their experiences and approaches, emphasizing the importance of careful dissection, complete releases, and proper post-operative management. Christopher highlighted the variability in surgery times for carpal tunnel releases and suggested using a monocryl P3 needle for closures. They also discussed the management of bilateral carpal tunnel surgeries and the potential challenges patients may face.