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  • April 16, 2014

Washington University Orthopedics - Ladue News: Health-wellness

Washington University Orthopedics

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Posted: Thursday, September 20, 2012 10:26 am | Updated: 2:55 pm, Fri Sep 21, 2012.

With a number of talented hand and wrist specialists coalescing at Washington University Orthopedics, forming the Peterson Hand Center was an obvious next step. “We really do have a group that offers one-stop shopping,” says co-chief of service Dr. Martin Boyer. “There’s really nothing in the hand, wrist and upper extremities that we don’t do: everything from carpal tunnel release to transplantation of bone and microsurgery to restore circulation, and also transplantation of toes to restore hand function. The patient can be fairly certain that whatever their hand or wrist problem, we have the expertise.”

That expertise is important to patients, whether they’re suffering from a common ailment like carpal tunnel, or from something rarer such as a child born with birth abnormalities, adds co-chief of service Dr. Charles Goldfarb. “This is what we do; we don’t dabble in hand surgery. We have committed our professional lives to patient care and enhancing the field of hand surgery, working with the science and moving it forward.”

Often, it’s difficult for patients to determine when they should come in for treatment, the doctors say. “Usually if there’s been an injury and there’s swelling, bruising or deformity, it probably should be evaluated,” Boyer says. “If there’s not been any injury and none of the above, then there’s no emergency, but obviously the patient will get to the point where he or she is wondering if the level of pain or dysfunction can be improved upon by simple measures. It boils down to: If you think about it, you probably should do it.”

For patients with carpal tunnel, the initial doctor’s visit often comes when discomfort starts interfering with their sleep, Goldfarb says. “The most common complaint is waking up at night with numbness or tingling. The time to visit the doctor is when numbness and clumsiness with the hands interferes with their lifestyle. There are not just Band-Aids, but solutions, to this.” Treatment for carpal tunnel often will begin with a splint worn at night, which sometimes provides a cure, but often only temporary relief, he notes. For some patients, steroid injections are a secondary option, and the final resort is surgery. “Some 80 to 85 percent of patients can be cured with surgery,” Goldfarb says, adding, “It’s an outpatient surgery that takes less than 30 minutes, and it has a relatively quick recovery and good outcomes.”

In addition to patient care, the Hand Center also has a research component, and many of the studies focus on predicting whether surgery will be effective in various situations, Boyer says. “It’s a hand center—not a hand surgery center. We treat people with hand problems, and that doesn’t necessarily mean surgery is part of the equation,” Boyer says. “We treat patients in the simplest, best way based on that patient’s needs and our understanding of the condition that we’ve diagnosed.”

In addition to Drs. Boyer and Goldfarb, the center also includes Department of Orthopedic Surgery chairman Dr. Richard Gelberman, as well as Drs. Ryan Calfee and Dan Osei. Dr. Lindley Wall will join the practice in 2013. “We all have areas of interest, so even if I see a patient whose problem is not my specialty, it’s seamless to have that patient connect with the other doctors to not have their care start from zero,” Boyer says. “We have conferences together, go over journal articles together, do research together—we do everything except live together. We even operate together if there’s a certain case that demands a greater level of expertise. The patient is well served by having all of us participate.”

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