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Thu, 23 Apr 2020

Everything You Need to Know About Endoscopic Cubital Tunnel Release

While Endoscopic cubital tunnel release might sound intimidating, it shouldn’t if you have a great orthopedic hand doctor. It is a minimally invasive, surgical technique that uses cutting-edge technology. This is a surgery used to treat cubital tunnel syndrome, also known as ulnar nerve entrapment at the elbow. 

The cubital tunnel is located behind the bony bump on the inside of the elbow. When someone does Endoscopic cubital tunnel release, they are trying to decompress the ulnar nerve, where it passes through the cubital tunnel. This is essentially to give the nerve more space. Similar to carpal tunnel, the tunnel-like structure that is the cubital tunnel can sometimes pinch the ulnar nerve. This nerve controls the sensation to the pinky and ring fingers as well as the hand and inner side of the forearm. This compression makes hands and arms to often begin to feel a numb and tingling sensation. Sometimes, beyond just numbness and tingling, the compression of the ulnar nerve can affect the gripping and motor skills of the hand, due to the small muscles attached. It will often feel like it does when someone hits their funny bone really hard because the ulnar nerve is the thing otherwise known as the funny bone.

Signs of cubital tunnel syndrome:

  • Pain on the inside of the elbow
  • Numbness, pain or tingling in the hand
  • Feeling like the pinky has fallen asleep, especially when the elbow is bent.
  • Loss of muscle mass in the hand (muscular atrophy)
  • Lack of coordination and weakness in fingers
  • Difficulty gripping things, especially with the ring and pinky fingers

If your condition is keeping you from being able to do everyday activities, surgery is often suggested. It is best to see a specialist for this, such as Miller Orthopedic’s hand doctor, Dr. Caliste Hsu. She is trained in this type of surgery. The first step in the surgery would be making a very small incision behind the bony bump in the elbow. This is followed by taking a couple of tools, such as retractors, and putting them in the incision to help locate the ulnar nerve from the other nerves. Then a small camera on a tube is put into the incision, this is the portion that makes the procedure endoscopic. The camera allows the surgeon to see inside to determine the best way to decompress the ulnar nerve and then stabilize it. Once it is determined that the nerve and elbow are stable, the surgeon removes the tools and stitches the patient back up. The camera allows for the surgeon to see what cuts are being made without having to make a large incision, such as what is required when doing open cubital tunnel release. Patients can often return to work in about a week following the surgery. Keep in mind that this can vary based on the line of work and what is required for their occupation.

The minimally invasive method is important for a faster recovery because of less scarring, pain, and swelling than other methods of cubital tunnel release. Sometimes, after this surgery, it does take a decent amount of time to for the person regain all of the previous sensations they once felt.

Some advantages of endoscopic versus open cubital tunnel release:

  • Smaller incision
  • Less pain post-surgery
  • Smaller scar
  • Quicker recovery
  • Less pain and trauma to tissues and in surgery

Most patients who qualify for open cubital tunnel release also qualify for endoscopic cubital tunnel release. If you want relief from your cubital tunnel syndrome with less pain and less recovery time, then come in and see Dr. Caliste Hsu at Miller Orthopedic today!

Mon, 14 Oct 2019

Treatments for Osteoarthritis in the Hand

A woman holds her hand after experiencing arthritis pain in her hands.Osteoarthritis is a common cause of hand pain. This disease is one of the most common forms of arthritis. This is a very common reason people experience pain or stiffness in their hands. Osteoarthritis is a form of degenerative arthritis, meaning the cartilage is being broken down due to the rubbing of bones on other bones. This often causes pain, inflammation, decreased range of motion, and stiffness.

If you are experiencing osteoarthritis there are a few things you can do to help ease that pain in your hands. Different things work for different people, so it is important to note that not everything will provide relief for all.


Hand exercisesExercise is one thing that can help ease the pain. This is something that might be painful during, but it can help build up those muscles around the arthritic joints. Maintaining daily range of motion is very important in helping with arthritis. This can help minimize some of the stiffness and help gain some strength in the hands that otherwise might dissipate as arthritis progresses. So it is important to do various squeezing and stretching exercises every day.

Ice and Heat

Moist heat is another option that can help with some of the stiffness or pain. This is something that can be really good before a lot of use in the joints, such as first thing in the morning. Icing arthritic joints at the end of the day or activities can help. It is important to only ice or heat them for no longer than about 20 minutes at a time. These are both simple, inexpensive ways to help relieve some pain.

Cortisone Injections

A cortisone injection is often a treatment method for those with Osteoarthritis. This can help patients regain some range of motion and reduce some pain. It is important to note that this does not always work for everyone.

The things listed above are just a few common, non-surgical methods used to help relieve some pain caused by arthritis in the hand. These are good things with which to start once diagnosed with osteoarthritis in the hand. However, these are not cure-all options and many times patients eventually need something more.

Orthopedic Surgery

While these treatments can help the process slow down and relieve some pain, osteoarthritis is currently a disease without a cure. Many people will look to surgeons to help assist them when they need more help than what they can do at home. Surgery is an option that is used once the conservative treatment methods have failed. The goal of surgery can vary. Some include:

  • Restoring as much function as possible
  • Eliminating or minimizing pain to a tolerable level
  • Reconstructing joints
  • Fusing of joints

When needed, hand and finger joint replacement surgery can be done, similarly to how knee and hip replacements are done for arthritis.

Contact a Hand Specialist at Miller Orthopedic

If you are experiencing hand pain, visiting a hand specialist who can provide a proper diagnosis and treatment is important. Dr. Caliste Hsu is a hand surgeon who is fellowship-trained and Board Certified. She can help work with patients experiencing hand pain or arthritis. Through a thorough examination, Dr. Hsu will come up with the best treatment plan for each individual patient.

Thu, 20 Dec 2018

Carpal Tunnel Syndrome

   The carpal tunnel is a narrow passage in the wrist that protects the main nerve of the hand and the tendons that move and flex the first three fingers.   The actual tunnel is made up of bone, tendons, tissue and nerves that run up the arm travel into the hand, palm, fingers, and wrist to allow for free movement.  If the tunnel swells, this pressure and inflammation will affect the inner nerves causing severe pain, and tingling or numbing sensations known as carpal tunnel syndrome.

Common symptoms of carpal tunnel syndrome include burning, tingling or numbness in the palm of the hand and along the fingers, especially the thumb, index and middle finger. These feelings may intensify to the point where it becomes difficult to hold small objects or to make a fist. The pain associated with this condition can range from mild-to-severe.  As the syndrome progresses, symptoms may be felt during the day when using the hand.  People may also experience weakness in the hands, clumsiness, decreased grip strength and difficulty in doing tasks where manual dexterity is required.  If left untreated it can lead to muscle damage. Carpal tunnel syndrome may increase gradually with symptoms usually first noticed at night.  If left untreated it can lead to muscle damage.

There are many causes and risk factors that increase the chances of getting carpal tunnel syndrome. A wrist dislocation or fracture may create a change in pressure in the carpal tunnel, increasing the chances for median nerve damage. Women are more likely to have this condition because of the smaller carpal tunnel. Obesity is also a common risk factor.  Fluid retention, specifically during pregnancy or menopause, can increase the pressure on the median nerve as well. If you have certain medical conditions such as diabetes, rheumatoid arthritis, osteoarthritis, kidney failure, or thyroid disorders, there is an increased risk for carpal tunnel syndrome.

In order to diagnose carpal tunnel syndrome, a physician will start with a physical examination and run a few different tests. These can include an X-ray that can rule out any other wrist pain such as a fracture or arthritis, an electromyogram that evaluates the muscles of the arm and hand, and a nerve conduction study that shocks the median nerve.

There are many ways to treat carpal tunnel syndrome depending on the severity of the condition. Those who have mild symptoms can treat their wrist discomfort and pain by frequently resting their arms, avoiding any strenuous physical activity and movements of the arms, and applying ice packs if there is swelling.  If these do not provide relief in weeks, your doctor can provide other options. Wrist splinting can relieve the tingling and numbness, especially at night. Nonsteroidal anti-inflammatory drugs such as ibuprofen provides temporary pain relief. Corticosteroid injections can decrease the swelling and inflammation of the median nerve and have been found to be effective.

Surgery is an option if the carpal tunnel symptoms are severe, extremely painful, and if there is no progress after nonsurgical treatment. Carpal tunnel surgery relieves the pressure on the median nerve by severing the ligament producing the pressure that is irritating the nerve. This can be done by either endoscopic surgery or open surgery.

The risk of carpal tunnel syndrome can be reduced by maintaining a healthy body weight and managing conditions such as diabetes and rheumatoid arthritis that contribute to nerve damage and inflammation. Avoid sleeping on the wrists and maintain good posture, positioning, and grip in everyday tasks to reduce wrist strain. If you perform repetitive tasks at work or at home, take frequent breaks and change your hand positions. When working at a computer, ensure you are using good posture and your wrists are not in a flexed position when you type. You can also do wrist stretching exercises.

For more relief techniques or a proper diagnosis come see our hand specialists, Dr. Hsu.

Thu, 19 Jul 2018

Orthopedic for Constant Wrist Pain

orthopedic doctor for wrist pain

Whether we realize it or not, our wrists are always getting a workout.  From typing on a computer to carrying groceries or playing sports, we depend on our wrists to be in good shape all of the time.  Though it is a common complaint, wrist pain especially affects older individuals that strain their wrists during work or play.

The wrist is a complicated structure made up of many different bones, ligaments tendons. Injury to any of these different parts can cause wrist pain. It’s important to determine if your pain in brand new (also called acute) or if you’ve had it for some time (called sub-acute or chronic). Acute wrist pain is most often caused by injury or sprain, while longer lasting pain is usually due to wear and tear. In rare cases, wrist pain symptoms can be a sign of infection or systemic illness that may deserve further investigation.

Some common wrist pain causes include:

  • Repetitive Motions/Stress– Activities range from hammering, painting to typing – all done repetitively can cause stress.  This stress causes the tissues around the joint to become inflamed, causing stress fractures and much pain.
  • Sudden Impact– A fall in which you catch yourself on the palm of your hand can sprain, strain, or fracture the wrist.
  • Arthritis– Both osteoarthritis and rheumatoid arthritis cause pain to the joints, which includes the wrist.
  • Carpal Tunnel Syndrome– Carpal tunnel syndrome occurs when the carpal tunnel passageway is compressed, causing pain and even numbness to the wrist.
  • Cysts/ Nerve Compression– Cysts can cause a lot of pain to the wrists, even if they are small.

Since it’s a common problem, treatment options for wrist pain can seem overwhelming. The good news is there are easy, tried-and-true remedies that can be done in the comfort of your own home, and if those fail, a visit to the doctor can usually help.

At-home wrist pain remedies:

  • Painkillers: Over-the-counter drugs like ibuprofen or naproxen help treat inflammation that causes joint pain, especially from wear-and-tear or overuse. Tylenol is a reasonable alternative.
  • Brace: Using a wrist brace can help stabilize the joint and prevent painful movements.
  • Take a break: Sometimes fixing pain may require giving the joint a break from repetitive or strenuous tasks.
  • Optimize ergonomics: At the office, ensure your wrists are well supported and kept in a neutral position. Avoid typing with bent wrists or gripping the mouse too tightly.
  • Heat or ice packs: Some people find gentle heat helpful in relieving pain, while others prefer ice. Try both and see what works for you.
  • Pain creams: Topical medications contain ingredients like menthol or capsaicin that can make joint pain less noticeable.

Sometimes the pain may persist despite these steps and may require further evaluation and treatment by your doctor.

Other wrist pain treatment options:

  • Steroid injections: This is a way of directly injecting anti-inflammatory medication into an area of pain.
  • Casting: Fractures are often treated by application of a cast.
  • Aspiration: If a cyst is the cause of your pain, the doctor can use a needle to remove the fluid inside.
  • Antibiotics: Only pain caused by bacterial joint infection or Lyme disease requires antibiotic treatment.
  • Rheumatologic medications: A rheumatologist can prescribe a wide range of medications if your joint pain is caused by autoimmune or crystal diseases.
  • Surgery: While a more invasive option, a surgeon can help relieve pain caused by nerve compression, fractures, cysts, or ligament tears.

You should see a doctor right away if:

  • Your joint is very warm, red, or swollen
  • You have sudden onset of weakness, especially if it affects an entire arm or leg or if you also have slurred speech or a droopy face
  • The pain is very severe
  • Your wrist is deformed, looks pale or is very cold, especially after trauma or a fall

If you are experiencing constant wrist pain and none of the home remedies are working for you, please call us at Miller Orthopedic Specialists. Our orthopedic specialists can get you the care you need. 

Fri, 28 Apr 2017

Carpal Tunnel Syndrome

Carpal Tunnel Hand

Carpal tunnel syndrome is a common condition that causes pain, numbness, and tingling in the hand and arm. Another symptom includes an electrical shock-like feeling mostly in the thumb, index and long fingers. The condition occurs when one of the major nerves to the hand — the median nerve — is squeezed or compressed as it travels through the wrist.

Most cases of carpal tunnel syndrome are caused by a combination of factors. Studies show that women and older people are more likely to develop the condition.

Although it is a gradual process, for most people carpal tunnel syndrome will worsen over time without some form of treatment. For this reason, it is important to be evaluated and diagnosed by your doctor early on. In the early stages, it may be possible to slow or stop the progression of the disease.

If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved without surgery. If your diagnosis is uncertain or if your symptoms are mild, your doctor will recommend nonsurgical treatment first.

Nonsurgical treatments may include:

  • Bracing or splinting. Wearing a brace or splint at night will keep you from bending your wrist while you sleep. It may also help to wear a splint during the day when doing activities that aggravate your symptoms.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen and naproxen can help relieve pain and inflammation.
  • Activity changes. Symptoms often occur when your hand and wrist are in the same position for too long—particularly when your wrist is flexed or extended.
  • Nerve gliding exercises. Some patients may benefit from exercises that help the median nerve move more freely within the confines of the carpal tunnel. Specific exercises may be recommended by your doctor or therapist.
  • Steroid injections. Although these injections often relieve painful symp­toms or help to calm a flare up of symptoms, their effect is sometimes only temporary. A cortisone injection may also be used by your doctor.

If pressure on the median nerve continues, however, it can lead to nerve damage and worsening symptoms. To prevent permanent damage, surgery to take pressure off the median nerve may be recommended for some patients.

Endoscopic Carpal Tunnel Release is a minimally invasive procedure performed to relieve pressure on the median nerve, alleviating the pain of carpal tunnel syndrome and restoring normal sensation to the hand and fingers. The endoscopic technique is performed on an outpatient basis, creates less pain and scarring than traditional open surgery and allows for quicker recovery.

People experiencing pain and discomfort for an extended period of time should consult with one of our orthopedic specialists to evaluate their symptoms and devise a treatment plan to reduce pain and improve the quality of health. Contact Miller Ortho today!

Mon, 08 Aug 2016

Miller Orthopedic Specialists Announces New Hand Surgeon

Council Bluffs, IA 8/3/16 – Miller Orthopedic Specialists is proud to announce their newest hand surgeon Gavin D. O’Mahony, MD. He specializes in hand trauma; adult, pediatric and congenital hand conditions; carpal and cubital tunnel release; treatment for arthritis of the hand and wrist as well as treatment of injuries to the tendons, nerves and arteries.

Dr. O’Mahony received his Medical Degree in May of 2006 from Vanderbilt University School of Medicine in Nashville, Tennessee. Dr. O’Mahony completed his General Surgery Residency at Lenox Hill Hospital in New York, New York, in June 2011. He completed his Hand Surgery Fellowship at the University of New Mexico School of Medicine in Albuquerque, New Mexico, in July 2012.  Dr. O’Mahony practiced as a Hand Surgeon at Oklahoma University Medical Center for four years where he was also an Assistant Professor.

For over 44 years Miller Orthopedic Specialists has served the Omaha/Council Bluffs area. Their goal is to get patients back to optimum health as quickly and safely as possible treating patients with pain and conditions related to bones, joints, muscles and tendons. Whether a patient has a shoulder, elbow, hand, wrist, spine, hip, knee, ankle or foot problem, Miller Orthopedic Specialists has the physician who will help each patient return to an active and healthy lifestyle. Miller Orthopedic Specialists offers patients same/next day appointments for all orthopedic needs. Dr. O’Mahony will be accepting new patients at the Council Bluffs, Omaha, and Clarinda clinics. For more information or to schedule an appointment, please call Council Bluffs at 712-323-5333, Omaha at 402-991-9958, or Clarinda at 712-542-2176 or visit their website at millerortho.com.




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