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Home » Elbow

Endoscopic Cubital Tunnel Release in patients from the Bahamas

Posted on January 9, 2014 by Dr. Badia

Release of the painful ulnar nerve at the elbow is a common operation that is virtually always done via a large open incision. At Badia Hand to Shoulder Center, we have been doing the technique endoscopically, via a mini portal incision using an endoscope to release the ulnar nerve, often called the “funny bone”. This alleviates the numbness and pain, and allows the patient to use the arm immediately as this is done in Miami (Doral) as an outpatient procedure with local anesthesia. Virtually no therapy is required and the complications such as scarring, neuromas, and continued pain are almost never seen with the endoscopic approach.

Complete the form below to learn more about Endoscopic Cubital Tunnel Release.


Advances in Hand and Elbow Surgery

Posted on April 30, 2012 by Dr. Badia

The latest and most advanced techniques in hand and elbow surgery were presented at a medical conference held in Miami on March 19th and 20th. Seventeen experts offered presentations at the event, three of whom were local and the rest came from different places in the United States and the world, including Hong Kong, Paris and Buenos Aires.

“The conference is the only existing forum specifically devoted to upper extremity joint reconstruction. This includes advances in minimally invasive surgery. Currently, it is possible to use arthroscopy, not only for knees and shoulders, as we’ve done in the past, but also a miniature camera can be inserted in the wrist, or at the base of the thumb, allowing physicians to offer very specific diagnoses,” said Dr. Alejandro Badia, an orthopedic surgeon -whose subspecialty is surgery of the hand and the upper extremity, and who is in charge of organizing the event. He is affiliated with Kendall Regional Medical Center of Miami.

Dr. Badia regreted that too much money is spent in the United States on MRIs, which in many cases do not shed light on what is causing the patient’s pain, and he added, “It is best to perform minimally invasive surgery on an outpatient basis, using local anesthesia and a minute camera to view the joint, determine exactly what the problem is, and solve it all at once.”

The main disease that causes pain and deformation of the hands is arthritis.

According to official statistics reported by the United States Center for Disease Control and Prevention (CDC), one in five adults suffers from arthritis. The impact of this disease is significant. Approximately 38 percent (16 million) of the more than 42 million patients with doctor-diagnosed arthritis report arthritis-attributable limitations to their normal activities, and about 31 percent (over 8 million) report arthritis-attributable work limitation. This disease equally affects all ethnic groups, but it is more common in women than in men.

Arthroscopic surgical treatment of hand and elbow arthritis, by means of a special instrument measuring 1.9 mm or 2.7 mm in diameter, is a new technique, and for this reason it was the conference’s main theme.

“Many surgeons do not use these new techniques because they are not aware of them. What we are now doing for the wrist is similar to what was done in knee surgery thirty or forty years ago,” Dr. Badia explained.

One example of the available new options is minimally invasive knuckle surgery.

“Some of these topics are new even for specialists; for example, metacarpal arthroscopy, something in which I am particularly interested. There is no one performing this type of procedure in Latin America. I know this because I travel throughout the area speaking at conferences, and we have surgeons who come here from different countries for training. The conference makes it possible to develop these concepts, because even among specialists, there are many who do not understand them well and, therefore, choose not to use them, making it impossible for the public in general to benefit from the progress made in this field,” Dr. Badía said.

One of the topics generating great interest at this event was that of advances made in prostheses for elbow replacement. Dr. Mark Baratz, from Pittsburg, lectured on this subject. These prostheses are new and are used for treating arthritis which causes pain and deformity. “The first hip replacements were performed in England forty years ago, and everybody knows about them; however, elbow prostheses are not only unknown to the public in general, but also many colleagues are not aware of their existence,” Dr. Badia added.

Another topic of particular interest was the use of arthroscopy on the ulnar side of the wrist (the external side where a small bone protrudes). There is cartilage in that area which can now be repaired in a less invasive way. Dr. Pak Cheong Ho, from Hong Kong, was in charge of presenting this topic.

Minimally invasive treatment of synovial cysts of the wrist -that is, without making an ugly hand incision and with the added benefit of speedier recovery- was also dealt with at the conference. Dr. Carlos Zaidenberg, from Buenos Aires, was the one making this presentation.

At this conference, Dr. Badia presented advances made in surgery to the base of the thumb. These include the use of prostheses to replace that part of the human anatomy, in patients who have arthritis, a very common condition. This implant is very similar to the one used for hips. It consists of a metal head or ball that articulates in a plastic cavity.

Surgical demonstrations were performed illustrating various approaches to elbow, wrist and hand reconstruction. Of particular interest was an elbow arthroscopy case which was transmitted live to the hotel ballroom for open discussion with Dr. Badia and participants.

Ninety doctors took part in Miami’s first hand symposium. Over 200 participated in this second year. Not only hand surgeons were attending the conference, but also orthopedic surgeons in general, physical and occupational therapists, hand therapists, medical students and residents. The Web page for the conference was www.miamihandcourse.com.

 

By Alfredo Arango
Medical Editor

 


South Florida doctor only one in region performing minimally invasive procedure curing Cubital Tunnel Syndrome

Posted on September 13, 2011 by Dr. Badia

MIAMI, Florida — What is Cubital Tunnel Syndrome? Cubital Tunnel Syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow. There is a bump (made of bone) on the inner portion of the elbow (the medial epicondyle) under which the ulnar nerve passes. This site is commonly called the “funny bone”. It is here that the ulnar nerve lies directly next to the bone and is susceptible to pressure. When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers. Dr. Alejandro Badia is the one and only doctor in South Florida currently performing a minimally invasive procedure curing Cubital Tunnel Syndrome. Symptoms: Cubital tunnel syndrome symptoms usually include pain, numbness, and/or tingling. The numbness or tingling most often occurs in the ring and little fingers. The symptoms are usually felt when there is pressure on the nerve, such as sitting with the elbow on an armrest, or with repetitive elbow bending and straightening. Often symptoms will be felt when the elbow is held in a bent position for a period of time, such as when holding the phone, or while sleeping. Some patients may notice weakness while pinching, occasional clumsiness, and/or a tendency to drop things. In severe cases, sensation may be lost and the muscles in the hand may lose bulk and strength. The cubital tunnel.Treatment without Surgery: Symptoms may sometimes be relieved without surgery, particularly if the EMG/NCS testing shows that the pressure on the nerve is minimal. Changing the patterns of elbow use may significantly reduce the pressure on the nerve. Avoiding putting your elbow on hard surfaces may help, or wearing an elbow pad over the ulnar nerve and “funny bone” may help. Keeping the elbow straight at night with a splint also may help. A session with a therapist to learn ways to avoid pressure on the nerve may be needed. Endoscopic Cubital Tunnel Release Procedure: The innovative, newer endoscopic method performed by the American Hand Institute surgeons does not require a large incision or lengthy recovery time. This procedure, which the surgeons at the American Hand Institute perform, is less invasive, less painful and typically allows for faster recovery. “It is very important that patients know about this new alternative to treat the Cubital Tunnel Syndrome. Through a tiny incision a faster procedure can be done with less stress for the patient and less recovery time than the traditional surgery for this health condition. My patients have experienced an immediate disappearance of CTS symptoms after this procedure.” affirms Dr Alejandro Badia, world-renowned upper limb surgeon, who is now in India and has been in Jordan, Aman and Dubai, teaching colleagues this and other innovative new minimally invasive surgical procedures. CTS- Minimally invasive procedure.Open Cubital Tunnel Release Procedure: Many surgeons will recommend shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. The nerve may be placed under a layer of fat, under the muscle, or within the muscle. Some surgeons may recommend trimming the bony bump (medial epicondyle). Following surgery, the recovery will depend on the type of surgery that was performed. Restrictions on lifting and/or elbow movement may be recommended. Therapy may be necessary. According to the American Hand Institute only a few surgeons in the country offer this particular procedure. Dr. Alejandro Badia is the only one to offer it in South Florida. Alejandro Badia, MD, FACS is a hand and upper extremity surgeon. He studied physiology at Cornell University and obtained his medical degree at NYU, where he also trained in orthopedics. A hand fellowship at Alleghany General Hospital in Pittsburgh was followed by an AO trauma fellowship in Freiburg, Germany. He runs an active international hand fellowship, serves on the editorial board of two hand journals, and organizes a yearly Miami meeting for surgeons and therapists that are devoted to upper limb arthroscopy and arthroplasty (www.miamihandcourse.com). This international meeting is held at the world-renowned Miami Anatomical Research Center (M.A.R.C.), the world’s largest surgical cadaveric training lab that Dr. Badia co-founded in 2005. Endoscopic Cubital Tunnel Release scar. In 2008, he completed the Badia Hand to Shoulder Center, a fully integrated clinical facility for the upper limb encompassing digital radiography, MRI extremity imaging, Integra rehabilitation facility and the Surgery Center at Doral. More recently, Dr. Badia inaugurated OrthoNOW, the first immediate orthopedic care center in South Florida which is staffed by surgeons from the International Orthopedic Group (IOG), a group of surgeons from lower extremity, upper limb and spine subspecialties who also treat elective orthopedic problems in international patients. He is member of the ASSH, AAHS, AAOS as well as honorary member of many foreign hand surgery societies and President of ISSPORTH. Dr. Badia can be reached via www.drbadia.com, a patient education portal and website for hand surgeon academic exchange. Or by email: alejandro@drbadia.com. Photo 1: The cubital tunnel. Photo 2: CTS- Minimally invasive procedure. Photo 3: Endoscopic Cubital Tunnel Release scar.   View Article »


Acute elbow trauma and late reconstruction – Complex Articular Injuries of the Elbow

Posted on May 1, 2011 by Dr. Badia

The elbow remains one of the more unforgiving joints in its response to both trauma and surgical intervention. The complex articular relationships of humerus, ulna and radius coupled with a tight soft tissue envelope, make the elbow one of the more challenging joints in which to restore function.

As Orthopedic hand surgeons, we are best suited to treat these complex injuries due to our understanding of the anatomy and our less aggressive approach to soft tissue handling that is a necessity in the hand.

Radial head fractures remain the most common elbow injury with many allowing conservative treatment, but the displaced fractures are often the most challenging of all articular fractures. Adherence to AO principles of internal fixation is important. The medial collateral ligament should often be explored and repaired in many of these injuries. This attention to concomitant soft tissue injury is the key to a good functional result in the elbow.

Monteggia lesions are often extremely comminuted and may require a variety of fixation techniques to achieve stability. This is important if we are to begin early motion which is particularly important in this joint that is prone to contracture. Similar principles are involved in the treatment of intercondylar humerus fractures, where strict surgical techniques coupled with rehabilitation are a must.

In some cases, techniques of arthroplasty and even arthroscopy are indicated in addition to open reduction and internal fixation. The complex distal articular humerus fracture in the elderly may be best suited for immediate cemented total joint arthroplasty.   These salvage procedures may also be indicated in late complications or even nonunion scenarios about the elbow.

Arthroscopy is often ideal in managing the young and active patient. Improved visualization of the fracture as well as rapidity of recovery are reasons that will soon expand the use of this technique in also managing elbow trauma. Post-traumatic contracture will also benefit from the surgeon’s adeptness with the scope.

Complex elbow articular trauma is now being given the attention it deserves as they are some of the most difficult posttraumatic sequelae problems to resolve in orthopedics. More diverse surgical techniques along with closer attention by the hand surgeon will hopefully minimize the common late complications seen in this most challenging of joints.

Alejandro Badia, MD, FACS

 


Tennis Elbow or Lateral Epicondylitis

Posted on May 1, 2010 by Dr. Badia

Lateral epicondylitis is a tendonitis commonly known as “tennis elbow”, although the majority of people with lateral epicondylitis have never played tennis. The condition causes pain on the outside portion of the elbow over a bony prominence named the lateral epicondyle. Pain occurs with activities such as grasping, pushing, pulling, and lifting. As the process progresses, the pain may occur with limited activities or even at rest. Of note, a separate entity termed golfers elbow, or medial epicondylitis, causes pain on the inside of the elbow.

Anatomy
The lateral epicondyle is where the Extensor Carpi Radialis Brevis (ECRB) tendon inserts. This tendon attaches to the muscle that allows your wrist and fingers to extend.

Diagnosis 
The diagnosis is usually made based on the history that the patient describes to the healthcare provider, and a physical exam. There will be localized tenderness in the region of the lateral epicondyle. Pain is also often reproduced with the patient extending their wrist under resistance.

X-rays may be done to rule out other causes of elbow pain; however, these are typically normal. Very rarely are other imaging modalities, such as MRI (magnetic resonance imaging) needed.

Treatment – Nonsurgical 
Treatment Nonsurgical treatment mainly focuses on addressing the symptoms, but do not resolve the cause of the pain. Rest and proper stretching is the first step, combined with anti-inflammatory medications. Stretching is focused on the wrist extensor muscles. First, the extensor muscles are stretched with the elbow held in flexion, and later with the elbow extended. Finally, strengthening exercises are performed, focused on the extensor muscles.


Cubital Tunnel Syndrome

Posted on May 1, 2010 by Dr. Badia

Cubital tunnel syndrome is a condition brought on by increased pressure on the ulnar nerve at the elbow. There is a bump of bone on the inner portion of the elbow (medial epicondyle) under which the ulnar nerve passes. This site is commonly called the “funny bone”. At this site, the ulnar nerve lies directly next to the bone and is susceptible to pressure. When the pressure on the nerve becomes great enough to disturb the way the nerve works, then numbness, tingling, and pain may be felt in the elbow, forearm, hand, and/or fingers.

Symptoms 
Symptoms of cubital tunnel syndrome usually include pain, numbness, and/or tingling. The numbness or tingling most often occurs in the ring and small fingers. The symptoms are usually felt when there is pressure on the ulnar nerve, such as when sitting with the elbow on an arm rest, or with repetitive elbow bending and straightening. Often symptoms will be felt when the elbow is held in a bent position for a period of time, such as when holding the phone, or while sleeping. Some patients may notice weakness while pinching, occasional clumsiness, and/or a tendency to drop things. In severe cases, sensation may be lost and the muscles in the hand may lose bulk and strength.

Diagnosis 
The diagnosis of cubital tunnel syndrome can be made based on simple clinical tests and patient symptoms, and is confirmed by a detailed nerve conduction study. This study measures the velocity and the latency of the nerve impulses across the ulnar nerve at the elbow. Nonsurgical Treatment Symptoms may sometimes be relived without surgery, particularly if the nerve conduction study shows that the pressure on the nerve is minimal. Changing the patterns of elbow use may significantly reduce the pressure on the nerve. Avoiding putting your elbow on hard surfaces may help, or wearing an elbow pad over the ulnar nerve may help. Keeping the elbow straight at night with a splint may also help.

Surgical Treatment 
When symptoms are severe or do not improve with conservative treatment, surgery may be needed to relieve the pressure on the nerve. Many surgeons will recommend shifting the nerve to the front of the elbow, which relieves pressure and tension on the nerve. Some surgeons may recommend trimming the bony bump on the inside of the elbow (medial epicondyle). At Badia Hand to Shoulder Center, a newer, endoscopic method is used, which does not require a large incision or lengthy recover time. A small incision is made at the inside of the elbow, and an endoscope, which is a tiny camera, is inserted. This allows the surgeon to see the nerve and make a division over the nerve. This reduces the compression over the ulnar nerve that had been causing the symptoms.


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