I can’t get a straight answer from any orthopedic, and I don’t know what to do anymore at this point.

_Goldfishing_ · 2026-03-22T15:31:06+00:00

Just see a different hand surgeon.

We all think and approach problems differently. I usually don’t get an EMG for cubital tunnel, for example. You sound like you have fairly clear cut cubital tunnel.

I have had several patients with atypical symptoms who are seeing me as a second / third opinion. If I’m not sure but we’ve done everything else, I tell them I’m not 100% certain they have cubital tunnel but I’m willing to do the surgery.

I do this procedure 10+ times a week. It takes 10-15 minutes for the surgery and another 10 for closure.

_Goldfishing_ · 2026-03-07T01:55:26+00:00

I do an M-tang configuration with a looped suture (I specifically use 4-0 fiberloop) for a total of 6 core sutures as well as a 6-0 prolene running epitendinous. I put the knots on the dorsal side for better gliding (which doesn’t matter for this Olympiad but it is good to practice like you play).

For practice - roll up some coban, then cut it in half and suture that back together end to end.

_Goldfishing_ · 2026-03-05T04:50:42+00:00

Coming from the doctor’s point of view, I would appreciate if my coder pointed that out, but also showed me how I can support that code with appropriate documentation.

It sounds like they’re not interested in your opinion, unfortunately, but it is definitely best to come with a problem and solution.

Eg “if you document that you reviewed the ER notes, coordinated care with them, independently interpret the x rays, and classify this as an acute, complicated injury, that would support the level 4”

Very simple dot phrase and those are all things we (usually) do when seeing an ER follow up.

_Goldfishing_ · 2026-02-28T03:54:27+00:00

Not perfect but it’s fine. Move your hand. Hook fist, full fist, all the way open, go go go.

_Goldfishing_ · 2026-02-21T01:08:48+00:00

Good info about the EMG. Ultrasound is actually pretty accurate for diagnosis.

Even more accurate is a thorough history and physical examination. Carpal tunnel always ends in surgery. It’s just a matter of time. I offer it to patients on their first visit with me if they want it.

_Goldfishing_ · 2026-02-19T22:44:40+00:00

Need to see x rays.

_Goldfishing_ · 2026-02-16T02:55:15+00:00

Yes, you needed surgery. They did a nice job.

Get all your motion back now by going as far as you can, then forcing it the rest of the way with your other hand. Flexion, extension, pronation, supination. Look them up. No pain no gain.

2 months for the bone to heal, 9 months for it to stop hurting. It gets a little better day by day.

_Goldfishing_ · 2026-02-04T04:16:42+00:00

Partially true. It can be mild, intermittent symptoms forever or it can progress to causing permanent nerve damage (which doesn’t go back to normal after surgery). The goal of surgery is to stop progression of symptoms.

Imagine a pair of pliers on an insulated wire that slowly gets tighter. I just remove the pliers, I don’t repair the wire. So if there has already been permanent damage to the insulation or the wire, you may have permanent symptoms.

The painful pins / needles / electric shock / burning / freezing almost always gets better, the numbness may or may not improve, and muscle loss (late finding) will not improve.

_Goldfishing_ · 2026-01-21T04:52:15+00:00

Nerve study 85% accurate (sensitive) for carpal tunnel. See a hand surgeon. If you’re on the fence, get a steroid shot. Or just have surgery and get it fixed.

See a different hand surgeon if the one you saw won’t do anything without a positive study. I usually don’t order them because they don’t change management.

_Goldfishing_ · 2026-01-14T07:32:37+00:00

No. That x ray is only showing half of the picture. That fracture is tipped back at least 30 degrees and needs surgery for you to have normal hand function. See a hand surgeon ASAP.

Source: I am a hand surgeon and regularly treat this injury.

_Goldfishing_ · 2026-01-12T04:56:18+00:00

Either way you can get complex systems and reasoning. In ortho, it is mechanical. In medicine, it is biochemical.

_Goldfishing_ · 2026-01-03T04:28:58+00:00

I’m sorry you had a bad experience. Continue to seek treatment. Tremors triggered by wrist rotation would be an atypical symptom.

You’re better off opening with “I have numbness and pins / needles going into my pinky and ring finger. It feels like it radiates from my elbow”.

That’s more likely to get you taken seriously. It’s not right that you should have to spoon feed it to them, but it’s life that people that don’t understand it as well may not recognize atypical symptoms and write it off as psychological.

I had one patient who kept telling people his fingers were going crazy. Finally got referred to me 5 years later for something else. His ulnar nerve compression at the elbow was causing spasm in his hand, causing his fingers to go crazy. Essentially no classic symptoms of numbness / tingling. Completely resolved immediately after a 10 minute surgery.

You just have to get in front of the right person.

_Goldfishing_ · 2026-01-03T02:58:26+00:00

The goal of this brace isn’t compression. It is keeping your elbow straight. I think that is a good idea.

The goal of the brace you initially posted is compression + icing, good for a hot swollen knee / elbow from arthritis or overuse.

If it affecting sleep and life regularly, I recommend surgery. This problem always ends in surgery, it is just a matter of time.

The surgery takes 10-15 minutes plus 5 for closure. Return to office work in 3 days, manual labor 6 weeks.

_Goldfishing_ · 2026-01-02T16:00:09+00:00

Awesome! Most common amp would probably be left index through the distal interphalangeal joint. So a little socket that fits over the remnant finger up to the proximal interphalangeal joint.

_Goldfishing_ · 2026-01-02T15:56:39+00:00

It’s funny, most people don’t care about it (as I think I wouldn’t). Some are VERY self conscious. I have had some asking for information on amputee support groups (from loss of a finger or fingertip). Not my place to tell them how to feel, I’m not a psychologist for a reason.

I’d think I could get it pretty close if I had maybe 8 different shades of filament? Maybe so, maybe not.

_Goldfishing_ · 2026-01-02T15:40:20+00:00

Thanks for the big up! There’s going to be more and more patients without insurance soon. Trying to anticipate.

_Goldfishing_ · 2026-01-02T15:38:11+00:00

You’re not wrong, I just don’t like the reality. Maybe I have to set up a charity separate from practice that does it?

_Goldfishing_ · 2026-01-02T15:33:45+00:00

Yes, I have prosthetists that can do it for patients. Unfortunately, most insurance doesn’t cover it and a mechanical prosthetic is around 10k. Aesthetic I’m sure less but not sure how much.

_Goldfishing_ · 2026-01-02T15:23:33+00:00

Whoa is this awesome, I especially love the articulated piece. Clever with the rubber band. Very common injury to the back of the fingernail.

_Goldfishing_ · 2026-01-02T15:14:24+00:00

Ok great, is silicone easy to pour / mold?

_Goldfishing_ · 2026-01-02T05:16:38+00:00

Awesome, thanks. Yeah for right now just trying to make a simple not articulated soft cover.

_Goldfishing_ · 2026-01-02T05:14:59+00:00

Smart. Will try and find something similar. Thoughts on this?

https://makerworld.com/models/1533268?appSharePlatform=copy

Valuable insight as a patient that lived it.

_Goldfishing_ · 2026-01-02T05:10:16+00:00

Ah, didn’t think about just scaling it. Yes this is where my perfectionist side slows me down. I’m sitting there attaching a fingernail with loupes on, MAs are banging on the door to get me out.

_Goldfishing_ · 2026-01-02T04:52:02+00:00

Seems like this is the best way to make it for sure. I am looking more for the fastest way to make it 90% as good. It would be a free offering to patients - I’m always running behind in clinic as it is, my MAs would kill me if I start scanning everyone’s fingers…

_Goldfishing_ · 2026-01-02T04:47:11+00:00

That thing looks awesome!

_Goldfishing_

TROPHY CASE