Virtual Operating Room

💪 DISTAL BICEPS REPAIR 💪

If your distal biceps ever ruptures, you may feel like a pop or a rip in the front of the arm that can be audible!😳

With your biceps tendon detached, you will lose some elbow flexion strength, but you will actually lose substantially more supination strength (palm up) since that’s the primary role of the biceps.

Here is a single-incision endobutton technique that does a great job of firmly reattaching the tendon to its anatomic attachment on the radial tuberosity. This repair allows my patient to begin immediate elbow range of motion activities post-op.

I’ll typically have him return to most activities by around 3 months.💪

@peterdenoblemd @ModernOrthoNJ

#distalbicepsrupture #biceps #ElbowPain #orthopedicsurgery #orthopedics #elbowsurgery #upperextremity #distalbicepsrepair #physicaltherapy
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Complex TFCC arthroscopic repair

This was a combo type 1B and 2B tear that I operated on - check out the intra-op pics!

@peterdenoblemd @modernorthonj

#orthopedics #handsurgery #tfccrepair #wristsurgery #upperextremity #arthroscopy #shouldersurgery #DRUJinjury #wristinjury #orthopedicsurgeon #handsurgeon #handtherapy #occupationaltherapy #physicaltherapy
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REPAIR OF RETRACTED SUBSCAPULARIS & SUPRASPINATUS TEARS (via a transosseous repair technique)

When #rotatorcuff tendons are torn and retracted to the level of the glenohumeral joint, it’s often a gametime (intra-op) decision about whether a primary repair is possible versus requiring a reconstructive option (superior capsular reconstruction/pectoralis major transfer, etc.)

This was one of those cases. In addition, given patient’s age and chronic use of steroids for a medical condition, her bone quality was very poor, particularly along the lateral aspect of the greater tuberosity.

When these lateral anchors on the greater tuberosity started pulling out, it was a lifesaver to have a transosseous repair technique in my bag of tricks!

@peterdenoblemd
@modernorthonj

#rotatorcuffrepair #shouldersurgery #orthopedicsurgeon #physicaltherapy #orthopedicsurgeon #shouldersurgeon
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FIXING SNOWBLOWER FINGER INJURIES

This is most likely what your local hand surgeons are up to the day after a blizzard in your area! ❄️ 🩸

And on behalf of snowblower hand injury victims everywhere, I would humbly ask spouses, significant others, parents, etc, to cut them a TON of slack. Shame levels are off the charts, and I can guarantee they will never put their hands in a snowblower again!!

@peterdenoblemd @modernorthonj

#blizzzard #snowstorm
#snowblowerinjuries #snowblower #fingerfracture #nerveinjury #orthopedicsurgeon #handtherapy #occupationaltherapy #physicianassistant #upperextremity #orthopedics #intheor #handsurgery #handsurgeon #topdoctors
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Small Finger PIP Joint Replacement

My patient has been struggling with right small finger joint pain for years due to arthritis. After several cortisone injections and waiting it out, she finally couldn’t take it anymore!

Now she decided to proceed with a silicone joint implant. This will allow her to maintain her motion and get rid of her joint pain.

@peterdenoblemd @modernorthonj

#modernapproach #orthopedics #handsurgery #jointreplacement #upperextremity #orthopedicsurgeon #handsurgeon #handtherapy #occupationaltherapy
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Endoscopic carpal tunnel release is my preferred technique for CTS surgery.

Check out my 60 second tutorial!

However, I still rely heavily on the mini open technique for older patients with very severe and chronic CTS symptoms.

What is your preferred technique??

Big assist from my PA - @big_timetimmy_jim 💪💪

@peterdenoblemd
@modernorthonj

#upperextremity #carpaltunnelsyndrome #endoscopicsurgery #handsurgery #carpaltunnelrelease #handnumbness
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Wrist scope - peripheral TFCC repair

Before and After!

@peterdenoblemd

#wristscope #orthopedics #handsurgery #orthopedicsurgeon #handsurgeon #handtherapy #occupationaltherapy #TFCCtear #tfccrepair
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Abbreviated (60s) version of my thumb arthritis (basal joint) trapeziectomy/suture suspensionplasty. Enjoy!

@peterdenoblemd

#thumbsurgery #orthopedicsurgeon #handtherapy #occupationaltherapy #physicianassistant #upperextremity #orthopedics #basaljointarthroplasty #intheor #handsurgery #handsurgeon #topdoctors
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VOLAR GANGLION CYST EXCISION

@peterdenoblemd
@modernorthonj

#orthopedics #handsurgery #wristcyst #wristsurgery #upperextremity #orthopedicsurgeon #handsurgeon #handtherapy #occupationaltherapy
#privatepractice #ganglioncyst
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Surgical video of fixing a distal radius that extends a bit into the shaft with an extra long plate. Video shows lining up and clamping bone then holding it with screws in and out of the plate.
#distalradiusfracture #orthopedicsurgery #wristsurgery @davidratliffmd
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HOW TO REPLACE A SHOULDER

59-year-old man with a heavy labor job who developed severe shoulder arthritis and could no longer lift his arm over head due to pain and stiffness.

@peterdenoblemd @cherisedyal
#orthopedicsurgery #shouldersurgery #shouldersurgeon #orthopedicsurgeon #shoulderreplacement #shoulderarthritis #physicaltherapy
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HOW TO FIX A RADIAL SHAFT

Young man broke his radial shaft during a #juijitsu match. Here’s how I fixed it! - @peterdenoblemd

#radiusfracture #fracture #orthopedics #handsurgery #wristsurgery #elbowsurgery #upperextremity #shouldersurgery #DRUJinjury #wristinjury #orthopedicsurgeon #handsurgeon
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DUPUYTREN’S CONTRACTURE

This is what a Dupuytren’s contracture looks like right under the skin. This disorder of the palmar fascia feels and looks a lot like a tendon, however these “cords” reside just under the skin and can cause painless tethering of the fingers into flexion. The tendon itself is actually much deeper to the cord. Despite the recent advent of effective office-based minimally-invasive techniques to treat these contractures, an open fasciectomy like this one is still the best treatment option in some cases, and confers the lowest rate of recurrent contracture.

@peterdenoblemd @modernorthonj
#Dupuytrens #orthopedics #handsurgery #orthopedicsurgeon #handsurgeon #handtherapy #occupationaltherapy
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RADIAL TUNNEL SYNDROME
@peterdenoblemd

While many people are familiar with carpal tunnel syndrome, few have heard of this far less common (and no less painful) nerve entrapment pathology called RADIAL TUNNEL SYNDROME. It is characterized primarily by a burning, and at times excruciating pain in the proximal dorsal forearm that can arise out of the blue or after a trauma such as a motor vehicle accident. This syndrome often occurs along side cervical disk-related problems. It also may be the reason for a patient’s lingering forearm pain after a neck surgery or tennis elbow surgery.

Usually I’m able to get this pain to resolve in my patients via therapy, cortisone injections, and rest. In some cases, though, the pain persists and is so dysfunctional that I recommend surgery to release the posterior interosseous nerve (PIN), the motor branch of the radial nerve in the forearm. As you can see in this picture, I have carefully released the nerve from all of its tight overlying structures, including the supinator muscle.

The radial tunnel release has become one of my favorites over the years, as it works really well and patients are so happy when their burning/aching forearm pain is finally gone!

#orthopedics #nervesurgery #handsurgery #wristsurgery #elbowsurgery #upperextremity #nervesurgeon #orthopedicsurgeon #handsurgeon #handtherapy #occupationaltherapy #radialtunnelsyndrome #radialtunnelrelease #motorvehicleinjury
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Grade 3 AC joint separation -
ARTHROSCOPIC REPAIR w/ DOG-BONE TIGHTROPE.
@peterdenoblemd

I like this minimally-invasive technique for Grade 3 and higher AC joint injuries to achieve early pain relief, healing of the freshly-torn coracoclavicular ligaments/AC ligaments, and avoid late deformity and pain.

#shoulderiniury #shouldersurgery #acjointseparation #shouldertherapy #arthroscopy #minimallyinvasivesurgery #physicaltherapy #shouldertherapy
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Sometimes the diagnosis is tricky and challenging. Sometimes, not so much...
@davidratliffmd #handsurgery #emergencyroom #nailinhand
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Video: How I Do An Endoscopic Carpal Tunnel Release, Wide Awake – Dr. Peter DeNoble

Transcript:

Hey guys, it’s Dr. DeNoble here. I’m going to show you how I do my endoscopic carpal tunnel releases in 60 seconds. Now I do these procedures under straight local, which means the hand is numb but my patients are wide awake. They’re usually listening to the music of their choice and, for about 15 minutes, hanging out with us, chit-chatting and very comfortable. I start by making an incision in the middle of the Palm about a centimeter and a half in length. I gently retract the skin edges with retractors and insert a clear cannula. Once the clear candle is inserted into the carpal tunnel, I take a look. I make sure that there’s nothing interposed between me and the transverse carpal ligament. Once I am comfortable that there’s a nice track, I mount a blade on the head of the scope and from a district approximate direction, I advance this very gently. As you’ll see, as I draw it back, the fibers have spread nicely and the release has almost finished. I then advanced one more time to complete the release and that’s it. A couple of stitches, small incisions, happy patients.

Video: Wrist Fracture-Dislocation – Transscaphoid Perilunate Dislocation

A young man was in an ATV accident that resulted in scaphoid bone fractures and wrist dislocation. The fracture was reduced and pinned and bones in the wrist were pinned to allow ligaments to heal. Watch the full video below.

Transcript:

This is Dr. Ratliff from Modern Orthopedics of New Jersey. This video is discussing a wrist fracture-dislocation that occurred in a young man in a quad ATV accident. Here, you see a displaced fracture in the scaphoid bone. The lateral x-ray shows that the wrist is actually dislocated, the capitate should be sitting in the cup of the lunate. This is a perilunate dislocation.

The incision is placed at the back of the wrist with the hand to the left, going through the skin and subcutaneous tissues. Next, we’ll identify the extensor pollicis longus tendon, pulling on it to show that the thumb moves with the tendon and then tracing and exposing the tendon through its sheath. Next, the posterior interosseous nerve is identified at the back of the wrist, crushed, cut and cauterized to try to limit pain and problems down the road. The tendons within their sheaths are elevated away from the bone, using the scalpel to peel those tissues away and expose the capsule on the back of the wrist as well as the radius.

Once the capsule is exposed, we can begin to work on the joint itself. Here, you can see two transverse tears in the capsule that occurred from the injury, not preexisting, and then identifying a loose piece of cartilage within the joint, which won’t be able to heal. Now using the instrument into that dislocation to shoehorn it back into place and the joint is now reduced and in proper position, but the fracture is still remaining. So here, showing the bones now no longer dislocated.

Next, we can expose the wrist with a V-shaped incision in the capsule to show the bones within the wrist and the dislocation, which has now been reduced. But that fracture at the scaphoid is still there, which you could see just moving. The wires are put in as joysticks to manipulate the fracture, and then this wire holds the bone in the proper position. These are adjusted, and now we can see that the joint is well lined up. This instrument shows that the joint surface is smooth and the fracture is in good position. So further wires are adjusted and put into position into that bone to hold it in place.

With the majority of the fracture now fixed, a piece on the back had pulled off with cartilage but still had good healthy bone. So this was sutured back to the bone to hold it in place and stabilize those ligaments that are attached to it. Now the wires are driven distally out past the base of the thumb where they will remain buried for approximately 10 weeks. The joint can now move freely with the wires buried beneath the cartilage. The ligament between those two bones just adjacent to the fracture is now examined, and they’re noted to be moving in unison without any direct injury to the ligament.

The wrist bones themselves all need to be stabilized, so wires are placed on both sides of the wrist. These wires will crisscross all of the little bones in the wrist and hold them in place for 10 weeks to allow ligament and bone healing. The capsule that was opened is now repaired. [inaudible] bone is now fixed and held with wires and the dislocation is back in place.