Hands-on Care

Experience and innovation come together to heal the body’s most useful tool.

In one hand alone, there are 29 major and minor bones, 29 major joints, 48 nerves and 123 ligaments. That’s a lot of little parts that require expert care. The complexity of the hands can mean intricate medical issues and disorders, and require skilled surgeons to handle them.

Hand surgery“We do a broad spectrum of hand surgery — everything from tendon repair and reconstruction to nerve injuries and arthritis,” says orthopaedic surgeon Robert J. Neviaser, MD, Chairman of Orthopaedic Surgery. “We work on wrists, shoulders and fingers as well, with procedures such as nerve decompression for carpal tunnel, wrist, finger and thumb joint replacements and wrist reconstruction.”

Some patients have arthritis so severe that their hands are deformed. In this case, Dr. Neviaser and his colleagues apply their respective skills.

“If the patient had osteoarthritis, which comes from standard ‘wear-and-tear,’ we would fuse the fingertip joints since replacement does not work well with those joints,” says Dr. Neviaser. “We would replace the mid-joints with implants.”

For rheumatoid arthritis, which presents itself with inflammation, Dr. Neviaser says there are often associated tendon problems. “After replacement, we would reconstruct and realign the tendons, so that the fingers will move and tendons will move them,” he says.

In some cases, trauma patients sustain severe nerve injuries. Recently, Shar Hashemi, MD, a hand and peripheral nerve surgeon at GW Hospital, treated a young patient that came into the Emergency Department with an upper brachial plexus injury — a tear in the network of nerves that sends signals from the spine to the shoulder, arm and hand. To restore elbow function, Dr. Hashemi performed a Double Oberlin procedure, which is essentially transferring nerves from one part of the body to another.

“We are constantly trying to create solutions for our patients who are afflicted with complex neuromusculoskeletal conditions,” says Dr. Hashemi. “We translate what is being done in the research world to our patients.”

Surgery not a given for rotator cuff tears

rotator cuff physical therapyAccording to Andrew Neviaser, MD, Assistant Professor of Orthopaedic Surgery at GW Hospital, all rotator cuff tears do not need to be treated with surgery, but can be treated with physical therapy. “There are very subtle things that help us make that decision,” says Dr. Neviaser. “The small differences in patients and types of tears need to be considered, and understanding the natural history of the tear is important in knowing which ones may get worse over time.”

The ability to discern comes from long-term experience and having done a huge volume of procedures. “We at GWU’s Medical Faculty Associates have been at the forefront of shoulder surgery for many years, including the area of rotator cuff surgery,” adds Robert J. Neviaser, MD, Chairman of Orthopaedic Surgery. “Because GW is a teaching hospital, our ability to treat rotator cuff problems is constantly evolving.”