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Ask a Doc: Hand Surgery at Allegheny Health Network

In our Ask a Doc series, we sit down with physicians and other clinical experts across our networks, including at Allegheny Health Network (AHN), for a chat on an important health topic. In this edition, we’re talking about hand surgery with Dr. Bradley Palmer, who appeared on Medical Frontiers Radio on KDKA to discuss the same topic.

We do so many things with our hands. We use them to work, play and relax. We sometimes take our hands for granted — until we have a problem that keeps us from using them to the fullest. That’s when hand surgeons can help.

The Allegheny Health Network (AHN) Orthopaedic Institute is home to one of the most advanced hand surgery programs in the country. To find out more about what hand surgeons do, what problems they treat, and what capabilities AHN has in hand surgery, I talked to hand surgeon Dr. Bradley Palmer.

Bryce Walat (BW): What are some of the most common problems hand surgeons treat?

Dr. Bradley Palmer (BP): Contrary to our name, hand surgeons don’t work only on your hands — they also treat problems with your upper extremities, which includes your wrists, arms, elbows and shoulders.

Doctor examining his patient's arm

Hand surgeons treat pain in the hand, wrist, arm, elbow and shoulder.

The most common problems we treat as hand surgeons are carpal tunnel syndrome, cubital tunnel syndrome, trigger fingers, and tendinitis, bursitis and arthritis of the hand, wrist, elbow and shoulder. Along with that, we treat some sports-related injuries like tennis elbow and golfer’s elbow. We also treat a lot of traumatic hand injuries, such as broken bones and injured tendons and nerves.

BW: Do you use any non-surgical treatments for hand problems?

BP: Depending on your problem and how severe it is, we can recommend treatments like physical and occupational therapy, and, if required, cortisone injections. Because any surgery carries risks, we try to do surgery only in severe cases or if other treatments fail to work.

BW: Speaking of physical and occupational therapy, what role do these therapies play in treating hand problems?

BP: Hand surgeons are only one part of a team of hand and upper extremity care professionals. Physical and occupational therapists are two other important parts of this team, along with nurses and other therapists and technicians.

You do so many things with your hands. Any loss of function can affect your livelihood and ability to care for yourself and others, along with your overall quality of life. Even the best hand surgery has its limits in fixing pain, swelling and stiffness, and any surgery can have those as side effects.

Physical and occupational therapy can help to manage those problems. I’d even go so far to say that in many cases, our work as hand surgeons isn’t nearly as important as physical and occupational therapy in helping patients get the best possible hand function.

BW: How many hand problems are job-related?

BP: When you think of job-related hand problems, carpal tunnel syndrome from using typewriter, computer and mobile device keyboards comes to mind. But there’s no clear evidence that use of the computer, typewriter and mobile devices is the cause of carpal tunnel syndrome.

People who use power tools and other sharp tools like knives and saws have a significant risk of hand injuries. Speaking of power tools, there is evidence that the use of jackhammers and other power tools that vibrate can cause carpal tunnel syndrome and other repetitive injuries, as well as any repetitive, forceful hand, wrist, arm, elbow or shoulder flexion activities, like swinging a hammer, golf club or tennis racket.

BW: How can you protect yourself against hand injuries and other hand problems?

BP: Some hand problems, like arthritis, are a matter of aging and genetics, so there’s not much you can do to keep them from happening, other than leading a healthy lifestyle. That said, you can prevent or reduce your risk for injuries.

First of all, work and play the safe way.

  • Make sure you follow all safety procedures and use all the proper safety equipment when you use any potentially dangerous tools.
  • When you use a computer, watch out for bad habits like resting your wrists on the keyboard.
  • If you play golf, tennis or any other sport that involves a lot of hand and arm motion, make sure you warm up and stretch properly before you play.

BW: What makes Allegheny Health Network unique when it comes to hand surgery?

BP: We handle some of the most complex problems in our region, like serious hand injuries that require extensive surgery to repair, along with hundreds of routine cases every year. I think that the main thing that sets us apart is our team approach. The surgeons are very collegial and we work together with everyone to ensure the best possible outcomes.

We work hand in hand (no pun intended) with our therapists and staff to help speed up recovery and achieve the most function possible. Another key thing that sets us apart is that we have physical and occupational therapists that are certified hand therapists on our staff. These specialists are trained and certified in helping to work with hand and upper extremity problems. Not every health care organization has these therapists.

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