Problems with Hands, Wrists, Arms? ‘It’s Complicated’
Hand specialists are also experts in microsurgical techniques, having undergone additional, rigorous training in repair of the hand’s minute blood vessels and nerves which requires the use of an operating microscope.
“It’s complicated.” The phrase may apply to some human relationships but certainly holds true for the complex architecture providing function to a person’s hand, wrist, arm and shoulder. “Which is why patients should contact an experienced upper-limb specialist – not just an orthopedic surgeon — when anything goes wrong up or down this superhighway of interconnected bones, joints, tendons, ligaments, muscles and nerves,” says renowned hand and upper-limb surgeon Alejandro Badia MD. Dr. Badia and many of his colleagues note that our patients are often unaware that the specialty of hand surgery even exists and often ask, “What type of issues do you treat?”. This fact even led to the development of ISSPORTH (International Society of Sport Traumatology of the Hand), where a group of colleagues in Europe noted that many elite athletes seemed unaware of the specialties’ importance when it came to assessing and treating their sports-related wrist or elbow issues. Badia served as the international societies first president in 2011-12.
Of course, orthopedic surgeons, in general, address injuries and diseases of the musculoskeletal system. However, “hand specialists are also experts in microsurgical techniques, having undergone additional, rigorous training in repair of the hand’s minute blood vessels and nerves which requires the use of an operating microscope” explains Dr. Badia. Arthroscopic and minimally invasive techniques involving the wrist, hand and elbow are also the domain of the hand surgeon, and like Badia, many also focus on the shoulder due to its importance in controlling the entire upper limb function by placing the hand in space.
Badia completed fellowships in hand and trauma surgery following four years of orthopedic and surgical residency at New York University, preceded by a general surgery internship at the historic Bellevue Hospital.
German philosopher Immanuel Kant referred to the critical importance of the human hand by calling it “the visible part of the brain.” The same description could hold true for the wrist, arm and shoulder, which provide the necessary fulcrums and levers to give the hand motion and the strength to grasp, hold, lift, turn, work and play. The shoulder, for example, is one of the most complex joints in the body, powered by a collection of muscles and tendons (rotator cuff) and able to assume as many as 1,000 different positions.
The capabilities of the upper limbs are what set aside humans from other animals, states Dr. Badia, whose professional memberships include the American Society for Surgery of the Hand (ASSH) and multiple international orthopedic, hand and arthroscopic surgical societies. The human thumb function specifically separates us from other simians, for example.
“Considering the upper anatomy’s importance to overall quality of life, why wouldn’t patients contact an available surgeon who specializes in the care of the upper extremity for treatment of problems, including pain, that affect the function of their hand, wrist, arm or shoulder?”
Emergence of hand and upper-limb surgery as a subspecialty of orthopedic surgery is fairly recent, dating primarily to World War II when large numbers of battle-related hand injuries brought together a variety of specialists – general, orthopedic, vascular and plastic surgeons, as well as neurosurgeons – to treat and return function to soldiers’ hands. This multidisciplinary approach served as a model for development of special centers – and, later, professionals — for care of the hand.
Today’s rapid, ongoing changes in medical and surgical procedures for musculoskeletal disorders and development of new biomaterials — like tissue-engineered substitutes as replacements for skin or tendon grafts – to repair joints, ligaments and muscles make subspecialization within the field of orthopedic surgery almost mandatory. “No one physician can know and learn about study findings and advancements affecting every area of the skeleton,” Dr. Badia says.
As founder and medical director of the Florida-based Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic, Dr. Badia speaks from experience, having become internationally known for his treatment of a wide array of upper-limb disorders and injuries, including complex trauma, tennis elbow, carpal tunnel syndrome, ulnar nerve entrapment, shoulder impingement, wrist disorders, distal radius fractures, post-injury reconstruction and outpatient upper limb joint replacement. His patients have included well known sports professionals and corporate executives from Europe, South America and even Asia.
“Musculoskeletal pain is a leading reason why people visit doctors,” Dr. Badia says. “That’s why it is important patients select the right specialist to ensure quick, accurate diagnosis and receive the optimal therapy for resolving their problem.”
Just because a patient sees a hand and upper-limb surgeon – or any orthopedic surgeon, for that matter – does not mean surgery will be the recommended course of action. Conservative approaches, including anti-inflammatory medications, corticosteroid injections, splinting, physical therapy, or recommended stretching and home exercises, are often first line of treatment for many musculoskeletal conditions.
Surgery is only required when debilitating pain or disease persists, says Dr. Badia, who is also expert in use of alternative, nonsurgical approaches like orthobiologics – the harnessing of a person’s own biologic substances, including blood platelets and adult (mesenchymal) stem cells — to mitigate inflammation, relieve chronic musculoskeletal pain and repair orthopedic injuries when standard therapies fail.
Dr. Badia’s advice to patients:
- Do the research. Learn about the training and experience of specific doctors and clinics before selecting.
- Match the specialist with the problem. Consider a 2nd opinion with an upper-limb specialist should the problem involve the hand or upper extremity.
- Ask questions about treatment options.
Enhance the potential for treatment success by following the specialist’s directions.
“As specialists and subspecialists in orthopedics, we do more than mend bones and fix joints,”
Dr. Badia adds. “We apply the latest therapies to treat a myriad of disorders affecting nerves, muscles, ligaments and other structures of the musculoskeletal system.”
Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a walk-in orthopedic care clinic. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons and an honorary member of many international professional hand societies. Dr. Badia specializes in treating all problems related to the hand and upper extremities, including trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. Go to OrthoNOWcare.com and drbadia.com.
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