Message from the AAHS President: Nash Naam, MD
Nash Naam, MD
AAHS President
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The Coronavirus pandemic has invaded all corners of the world. It is having a significant impact on all aspects of medical care everywhere. Most of us do not perform elective surgeries in order to maintain our resources to serve those infected with this virus.
Many medical conventions have been cancelled at least for the next few months. All of us hope to get back to some normalcy sooner than later. But the safety and the health of our patients and our citizens have to be the first important objective that we should concentrate on before any type of normality comes back.
This cruel pandemic re-introduced the real heroes in our societies namely, the physicians, nurses, respiratory therapists, lab technologists and others who are at the front line doing extraordinary heroic acts defending our citizens against this dreadful virus pandemic. We salute all of you who are putting your lives on the line to protect, treat and support patients with Coronavirus.
As the situation of this pandemic is very fluid and things are changing almost hourly, AAHS, has been trying to be on the forefront of this battle by informing our members of the important issues relevant to their practices. Periodic emails will be sent to our members outlining relevant data and recommendations from our larger sister organizations such as the American College of Surgeons, the American Medical Association and the American Academy of Orthopedic Surgeons, as well as Center for Disease Control and Prevention.
As most of us are hunkering down at home being unable to travel to attend medical conferences, AAHS has strived to ensure continuation of hand surgery education during these unsettling times. Our educational committee Chair, Josh Abzug, MD, has pioneered an initiative to provide our members with online-based education in form of Webinars. These Webinars, which run every Sunday evening, are free to our members and are geared towards residents and fellows as well as hand therapists and advanced providers. Our thanks and appreciation are extended to Josh and his committee, and to the webinar faculty: Joshua Abzug, MD, Don Bae, MD, Andrea Bauer, MD, Roger Cornwall, MD, Kyle Eberlin, MD, John Fowler, MD, Martin Herman, MD, Jonathan Isaacs, MD, John Herzenberg, MD, Christine Ho, MD, Scott Kozin, MD, Dawn LaPorte, MD, Suhail Mithani, MD, Amy Moore, MD, Terry Light, MD, Kevin Little, MD, Heather Lochner, MD, Scott Oishi, MD, Peter Rhee, MD, Julie Samora, MD, Carley Vuillermin, MD, Theresa Wyrick, MD, Dan Zlotolow, MD. The Webinars have been very successful with registration numbers in the 500’s and 600’s. Josh and his committee are planning to continue this series of free webinars through, at least, the end of May.
Our program committee under the capable direction of our program chairs: Julie Adams, MD and Mark Rekant, MD are working hard along with Vanessa Smith, PA-C and Cindy Ivy, OTR/L, CHT and Crystal Beatrice, our meeting manager, to create a memorable meeting in Kauai, in January. AAHS leadership will be continuously evaluating Coronoavirus related impacts on our communities and the healthcare system as we prepare for the meeting in Kauai. The membership will be updated as we approach January 2021.
Again, I would like, on your behalf, to extend our deep thanks and appreciation for the continued excellent work to our Executive Director: Sarah Boardman and Crystal Beatrice, Angela Silvestri, Aviana Fiore and Yvonne Grunebaum.
I wish you all the best in the coming weeks and months. Stay vigilant and continue to do your excellent work to help our patients and our communities. Usually, in tough times, the quality and the commitment of our members working day in and day out to help our patients shine brilliantly more and more. I am really very proud and very grateful to be the President of such a vibrant and relevant organization.
Keep up the great work!
Please feel free to email me at any time. I would welcome any comments or questions.
Please stay safe and healthy.
Sincerely,
Nash Naam, MD
nashnaam@gmail.com
Free Webinars During COVID-19 Crisis
The AAHS is offering FREE weekly, educational webinars for residents and fellows as well as hand therapists and advanced practice providers to facilitate ongoing education during the COVID-19 crisis. These webinars will take place on Sunday evenings and will also be recorded for later viewing. Register for upcoming webinars and view recording webinars on the AAHS website.
AAHS Webinar: Brachial Plexus Injuries
Sunday, May 10, 2020, 7:00 – 8:00 PM Eastern Time
 Register for this webinar
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AAHS Webinar: Distal Radius Fractures
Sunday, May 17, 2020, 7:00 – 8:00 PM Eastern Time
Register for this webinar
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AAHS Webinar: Carpal Instability
Sunday, May 24, 2020, 7:00 – 8:00 PM Eastern Time
Register for this webinar
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AAHS Webinar: Adult Carpal Fractures and Dislocations
Sunday, May 31, 2020, 7:00 – 8:00 PM Eastern Time
Register for this webinar
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Best Hercules or Holmes Case
During the 2020 Annual Meeting, AAHS debuted a new session, “Best Hercules Cases vs. Best Holmes Cases.” This session was moderated by the expert panel of judges of team of Drs. Mark Baratz, Jeff Greenberg, and Amy Moore, and the best cases submitted to this competition were presented to the AAHS audience. After critique, the audience decided which exhibited the most heroic efforts, surgical prowess, and "brute force" to conquer a formidable challenge and which employed the most clever, cunning, and innovative solution to crack a difficult case. In this issue of Hand Association News and in the subsequent issues this year, these cases will be featured. The Hercules winner is featured in this issue!
Size Matters Not: Youngest Functional Muscle Transfer for Restoration of Hand Function in a Four Month Old Infant
Tim Schaub, MD
Associate Professor of Surgery
Creighton University
Director of Hand Surgery
Phoenix Children's Hospital
JJ is a four-month old boy who presents to the emergency department immediately from a visit from his pediatrician with a two-week history of a growing mass on his left forearm (Figure 1). The mass is solid, non-mobile and painless. No abnormalities were noted on prenatal ultrasound and the family gives no history of trauma. X ray of the left forearm shows a soft tissue density with no boney involvement (Figure 2). An ultrasound reveals a 4.9 x 1.4 x 2.3 cm mass that is well circumscribed, hypervascular, intramuscular/intermuscular with internal striations. It does not appear to extend to skin or underlying radius and ulna. An MRI is performed which shows a 5.1 x 1.7 x 1.8 cm mass in extensor muscles left forearm and the findings are concerning for infantile fibrosarcoma versus rhabdomyosarcoma (Figure 3). An open biopsy is performed for definitive diagnosis and this confirms the mass to be an infantile fibrosarcoma. Based on recommendations of our multidisciplinary oncology group, with complete surgical resection there would be no need for chemotherapy or radiation therapy postoperatively.
The patient undergoes complete oncologic resection with the assistance of an orthopedic oncologist. This resection removes the muscles and tendons of extensor compartments 1, and 3 through 6 (Figure 4). The posterior interosseous nerve is tagged and the second extensor compartment left intact. A wound vac is placed until final pathology is confirmed. Subsequently, the margins are negative on pathology. The planned reconstruction requires restoration of finger extension and coverage of the exposed bone and soft tissue that will allow unrestricted growth with the patient. A functional gracilis muscle with a skin paddle is designed from the contralateral thigh with microsurgical clips placed at 1 cm- intervals for post-flap elevation tensioning. An end to end anastomosis is performed to the radial artery and a vena comitans and the branch of the obturator nerve to the gracilis is coapted via neurorrhaphy to the posterior interosseous nerve remnant at the level of the supinator (Figure 5). A piece of bilaminar dermal substitute is used to offload tension on the flap, and a week later this is removed and the flap closed completely (Figure 6). At six weeks post operatively, the muscle shows signs of firing. At 6 months the patient has full wrist flexion and extension and full finger flexion and extension (Figure 7). We plan for a palmaris longus to extensor pollicis longus tendon transfer at 2 years of age. There is no evidence of recurrence of the tumor at one year. This is a report of the first successful functional muscle transfer in an infant.
Read more on Size Matters Not: Youngest Functional Muscle Transfer for Restoration of Hand Function in a Four Month Old Infant
Therapist Corner:
Does Botox for migraine on EDS or hyper-mobility syndrome patients set them up for future problems?
Saba Kamal, OTR, CHT
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What is Migraine?
Migraine is more than a headache. It is a distinct neurological disease that changes brain biology and function.
Migraine is a long-term disabling disease that can profoundly impact someone’s ability to carry out everyday activities like attending family events or going to work. Migraine can also be difficult on family members—partners, parents, children and relatives.
How does Botox help for Migraine?
The pathomechanism of chronic migraine has not been fully elucidated. The mode of action of onabotulinumtoxinA in the treatment of chronic migraine is suggested to be related to the inhibition of the release of calcitonin gene-related peptide and substance P in the trigeminovascular system. Randomized clinical trials demonstrated that long-term onabotulinumtoxinA fixed-site and fixed-dose (155-195 U) intramuscular injection therapy is effective and well tolerated for the prophylactic treatment of chronic migraine.
What is EDS?
Joint hypermobility syndrome (JHS) and Ehlers-Danlos syndrome, hypermobility type (EDS-HT) are two clinically overlapping heritable connective tissue disorders strongly associated with musculoskeletal pain, fatigue and headache. It may also present with neurologic manifestation including migraine.
How many patients with EDS / hypermobility syndrome suffer from Migraine?
Migraine with or without aura is considered the most common form of headache in JHS/EDS-HT.
However, most patients with Migraine are unaware of whether they also suffer from JHS/EDS-HT. It is the most undetected diagnosis. Individuals with EDS may be prone to migraine due to an inherent disorder of connective tissue impairing the stability of the joints. This in turn increases pressure in these patients suffering from migraines on the surrounding tissues increasing pain and inflammation thus making the tissue hyperreactive causing acute symptoms but continuously resulting in a long term presentation of the problem.
Results in a
study of migraine characteristics in Joint hypermobility syndrome a.k.a Ehlers Danlos Syndrome, hypermobility type by Puledda F Et all showed that in JHS/EDS-HT: (1) migraine has an earlier onset (12.6 vs 17 years of age; p = 0.005); (2) the rate of migraine days/month is higher (15 vs 9.3 days/month; p = 0.01); (3) accompanying symptoms are usually more frequent; (4) HIT-6 and MIDAS scores are higher (p = 0.04 and p = 0.03); (5) efficacy of rescue medication is almost identical, although, total drug consumption is significantly lower (p < 0.04). Joint hypermobility syndrome and Ehlers-Danlos syndrome, hypermobility type patients have a more severe headache syndrome with respect to the MO group, therefore demonstrating that migraine has a very high impact on quality of life in this disease.
How do these patients present in therapy?
Most of these patients suffering from EDS-HT syndrome are unaware of the diagnosis. They mostly present with fibromyalgia diagnosis, multiple neurological or myofascial pain complaints like tendonitis etc.
On further examination it is revealed that they present with EDS-HT and have been suffering from Migraines along with other peripheral nerve / muscular pain as part of their broad chronic pain symptoms.
EDS presents with hypermobility, which may ultimately lead to early arthritis.
EDS-HT patients have soft to almost no end feel in their joints. Their ligaments are too lax, thus fail to provide proprioceptive input to their joints. These patients always complain of tightness in their joints even when they are the most hypermobile patients. They never feel like they get enough stretch, so they keep stretching which causes exacerbation of symptoms. The cycle continues as they add to the problem. This over stretching causes surgeries to fail and they stretch the repairs out. It may cause neurological symptoms due to the strain on the nerves thus they get diagnosed with fibromyalgia as no other problems are detected.
What is the treatment for patient with EDS-HT?
- Recommendations for patients that present with migraines or neck flare ups especially after sleep was to avoid stomach sleeping or sleeping with brace to prevent overstretching of the tissues in the neck and irritating the structures thus preventing these flare ups. Braces are also recommended for the neck while driving in severe cases. Oval 8 splints for the fingers to prevent hyperextension in the fingers yet allowing them to function in pain free range providing them with a definite end feel during loading activities. Goal with splints is to allow for functional activities while preventing wearing down of cartilage that may cause early arthritis.
- Exercises for upper extremity are preferred in lying down with head supported either face down or up. Thus, all postural exercises are instructed in being performed lying down on the table isotonic prone rows/ extensions, sidelying external rotation with head properly supported etc. PNFs if given had to be performed supine with T-Band instead of standing until stability is improved.
- The foam roll exercise which is part of postural correction / nerve gliding exercises are performed on the bed or with 3” roller to prevent excessive stretch on the anterior shoulder tissues.
- Patients are instructed to avoid weight bearing on hands especially pushups. Only fisted position is allowed in neural wrist.
- These patients complain of tightness in the tissues with aching. This pain tends to have a neural component, which is not relieved by stretching, partly because the joint stretches out without offering the flexibility of the tissues the patient is trying to achieve. Neural pain is managed with Myofascial Manipulation with nerve glides to glide the nerve (reduce pain / sensitivity) without overstretching the joints.
- Taping can be used between treatments to reduce pain & expedite the process to initiate neuromuscular re-ed. These patients lack end feel in the joints. Taping is done for proprioceptive input to provide that end feel and stabilization to prevent subluxation of the joints. Corrective taping also helps decrease the stress on the mechanoreceptors that cause pain & allow for neuromuscular strengthening to ensue as an exercise & with activities.
Recommendations in therapy:
Goal is to strengthen the secondary stabilizers since their primary structures (ligaments) are redundant.
- Mid-Range Strengthening or Isometrics of all joints including neck.
- The goal with rehab is to regain smooth & balanced motion, by adding dynamic muscle stabilization to compensate for poor ligament support & promote muscles that are joint protective to combine conscious & unconscious, providing stability while performing ADLs thus providing long lasting results & avoiding future problems. This is a combined effort achieved by splinting, taping and strengthening the right structures the in the correct manner.
Botox in undetected EDS-HT patients
Since ligaments are in a lax state in EDS-HT patients, the stability for the joints is dependent on the secondary stabilizers – the musculoskeletal system. It is strengthened in mid-range to prevent stress on the ligaments. However, if the Botox intramuscular injection therapy is done, it would weaken the structural mechanisms these patients rely on to maintain stability. Long term effects of which may be detrimental to these patients adding to more neuromuscular symptoms.
More studies and accurate assessment may be needed before Botox is prescribed to this patient population.
http://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/eosinophilic-esophagitis-connective-tissue-disorde.aspx
http://www.ncbi.nlm.nih.gov/books/NBK1279/
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2982.2009.01421.x/full
http://www.physio-pedia.com/Ehlers-Danlos_Syndrome
http://ednf.org/sites/default/files/MRGOphthalmologyS.pdf
http://ednf.org/sites/default/files/MRGDentistryS.pdf
http://www.jci.org/articles/view/12881
http://www.upright-health.com/ehlers-danlos.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365276/
http://ednf.org/assessing-joint-hypermobility
https://www.reviewofoptometry.com/ce/medical-syndromes-that-affect-childrens-vision
Other System Manifestations:
Obstetric/Gynecologic- Premature rupture of membranes, pelvic prolapse and dyspareunia
Oral / Dental- high narrow palate, tooth crowding, periodontal disease, TMJ dysfunction
Ocular- Myopia, keratoconus, dermatochalasis, microcornea, macrocornea, glaucoma, retinal detachment and
https://www.speakyourmigraine.com/migraine-impact-tool/
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Abstract Submission Open
The abstract submission site for the Hand Association's 2021 Annual Meeting in Kauai, Hawaii is now open. Please prepare to submit your best work! The deadline for submissions is July 12, 2020.
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Join AAHS on Social Media!
The AAHS Technology Committee and Social Media Subcommittee have relaunched the Hand Association’s social media accounts! Join us on social media!
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Recommendations from an AAHS Member on the Garden Isle of Kauai
Alyssa Carnegie, MD
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The island of Kaua’i, also known as the Garden Isle, has the honor of hosting the AAHS Annual Meeting in January of 2021. As a resident of the island for the past 5.5 years, I’m excited to share with you some of the sights, scenes and activities that await you. By briefly introducing you to this, the most beautiful of the Hawai`ian islands (a clearly biased opinion), I hope to provide even a brief but welcome distraction from the challenges we all currently face together in the midst of the COVID-19 pandemic.
There is much to see, do and enjoy outside of the host location, The Grand Hyatt Resort & Spa! Although, to be fair, for anyone who hasn’t stayed at the Grand Hyatt, the hotel is itself is a treat with the most incredible pool, beautiful gardens and Pacific Ocean views that are unrivaled.
In no particular order, here area few sights that shouldn’t be missed:
The Waimea Canyon: A number of geologic events including lava flows, wind and water erosion and collapse of land in the area resulted in the formation of this magnificent canyon, also known as the “The Grand Canyon of the Pacific”. I would recommend driving to the very end of the road, where there is an accessible lookout first– the Pu’u O Kila lookout. With good visibility, you will be overlooking the famous. Typically, arriving at or before 9 am will provide the best opportunity to see the valley before the heavy mist rolls in and obstructs a clear view of the valley. From the top of the canyon heading back downhill, check out the other lookouts for unbelievable views into the large canyon.
The Na Pali Coast: Along the extreme northwest coast of the island is the World famous Na Pali Coast. This iconic region features alternating towering sea cliffs and deep valleys. It takes only a few seconds of Google searching for Kaua’i to produce countless images of this amazing Hawaiian spectacle! Weather permitting, my favorite ways to experience the Na Pali Coast are catamaran, dinner cruise or helicopter.
Whale Watching: Although fewer whales tend to make the waters off the coast of Kauai home for the winter (Maui seems to be their favorite), the eastern and southern waters are often great spots for spotting humpback whales that migrate to spend the months of December through March in Hawaiian waters. Luckily in fact, the Grand Hyatt is a great location for spotting the whales right offshore. For the more adventurous, head out on a boat tour and hope for a more up-close encounter.
The Town Of Hanalei and Hanalei Bay: Located on the North Shore of Kauai is the World-famous crescent-shaped Hanalei Bay. Nestled at the edge of the picturesque town of Hanalei, no trip to Kauai is complete without visiting this impossibly picturesque town and beach - a huge favorite of locals and visitors alike. Be sure to stop briefly at the Hanalei Valley lookout before heading downhill into the town, for a birds-eye view of the valley, taro fields and surrounding mountains. Be on the lookout for “pop-up” waterfalls in the mountains!
Kauai By Air - Helicopter Tours: One of the most breathtaking experiences you can have here is to witness the spectacular beauty of the island from the air. By far the best way to see the rugged interior of the island, the Na Pali coast, Waimea Canyon and other areas otherwise hidden from view, a number of companies provide daily tours departing from the Lihue airport at regularly scheduled times. Island Helicopters Kauai provides tour options which include a brief landing at the waterfalls seen in the movie Jurassic Park. Regardless of which company you choose, the experience will be unforgettable.
Luau Celebrations: I was initially skeptical of attending a luau when we first moved to Kauai because I assumed it would be an overly “touristy” event. I have to admit that I was wrong. There are various luaus on island, (my favorite being Smith Family Garden Luau), which shares the cultural history of Hawaii. Luaus are a great option for a family night of fun outside of the resort.
Hiking: Hiking trails are too numerous on Kauai to provide any great detail here. Notwithstanding, a range of options will appear on any Google search, and particularly popular hike trails include Sleeping Giant and various Waimea Canyon trails. The book Kauai Trailblazer: Where to Hike, Snorkel, Bike, Paddle and Surf by Jerry and Janine Sprout is an excellent resource. A word of caution: hiking in Hawaii can be challenging, strenuous and in some locations and under adverse weather conditions, dangerous. Be sure to check the weather forecast before you set out and have a realistic understanding of the difficulty of the hike.
Snorkeling / Scuba Diving: There are many options, particularly along the South Shore (near the Hyatt) that offer snorkeling / scuba lessons and boat trips. The sea life that surrounds Kauai is spectacular - especially the sea turtles, and if you’re really lucky, spotting the endangered Monk Seal.
Kayaking: There are various kayaking tours – both out in the ocean and along rivers that offer another unforgettable way of seeing the island. One of my favorites is a kayaking tour of the Wailua River that leads to a short hike to “Secret Falls” (Uluwehi Falls).
Surfing / stand up paddleboarding: Various companies / locations offer rentals / lessons including shops in Hanalei, Poipu / Koloa, Wailua, and Kalapaki Bay.
Other sites to see:
- North Shore: Kilauea Lighthouse, Ke’e Beach / Ha’ena State Park (advanced parking permit /registration required)
- Eastern Side: Kauai's Hindu Monastery, Kauai Bike Path
- Southern Side: Spouting Horn, National Tropical Botanical Gardens
- Western Side: Kauai Coffee Company (tour available), Hanapepe town (check out the wooden swinging bridge)
Photos are one-time use courtesy of Jason Carnegie Photography, LLC. All rights reserved. © copyright 2020
2019 Vargas Recipient Report: Kumasi, Ghana
My name is Lisa Flewelling, MscOT, BscOT. I am an occupational therapist who works in hand therapy as a valued member of a wide-awake hand surgery team at my home hospital the Saint John Regional Hospital in New Brunswick, Canada. My Vargas outreach trip took me to Kumasi Ghana, for 2 weeks in early September 2019. This trip was a return trip to Kumasi: I visited in the same capacity as a therapist volunteer with Health Volunteers Overseas in 2016.
Presently onsite in Kumasi at the Komfo Anokye Teaching Hospital (KATH) there are 2 physiotherapists who are serving in the capacity of Lisa Flewelling, MscOT, BscOT hand therapists: Robert Sowa and Pokuaa Asamoah. These two therapists were working with this service during my visit in 2016 as well. The hand therapy site collaboration with HVO began in 2014.
Improvement on Site Goals:
During this return visit I saw that progress on several site goals was happening. One of the major goals of the site had been for therapists to improve inter-disciplinary communication and teamwork. This has improved dramatically. In 2016 the therapists had just begun to attend Plastic Surgery clinic with the surgeons once a week. Now this is a weekly occurrence and has resulted in more hand therapy referrals, improved timeliness of referrals and more appropriate referrals. By having therapists in the plastic surgery clinics the therapist and surgeon are able to work together as a team in designing a treatment plan for their patients post surgery during this time. They are learning from each other. This same set-up occurs at my home hospital.
The hand therapist is also regularly attending morning trauma rounds and they are frequently called by the emergency room residents and ortho surgeons for consultation on cases. Presently this is the only therapist/physician team at KATH and this is an area where future focus can continue to happen as therapy presence on the floors is limited at this time. The physicians and the hand therapists recognize this and are attempting to develop further interdisciplinary teams. Following a presentation I made regarding “pain-guided fracture management” a very good conversation was had between the ortho surgeons, residents and hand therapists about how increasing inter-disciplinary collaboration with the physio department could further patient care.
It was apparent that the hand therapists were seen as resources within their therapy department as therapists were frequently asking questions and for patient consults. Sowa was noted to speak with several offsite therapists in consult. This is a great gain.
Another site goal where improvements have been made is that the therapists are improving their knowledge and skills in treatment of upper extremity conditions. During my visit in 2016 the plastic surgery team at KATH did not identify Complex Regional Pain Syndrome as a condition that impacted their population. During this visit the hand therapists and I co-treated a client who had been diagnosed with CRPS post a carpal tunnel release surgery and the therapists were seeking treatment ideas. We fabricated and used a mirror box for the first time in the Dept. Other possible uses for the mirror box were discussed. As this is a new skill I believe follow-up will have to happen on future trips regarding the use of mirror box and hopefully GMI. In 2016 I had presented on mirror box and GMI to the Dept, but until this time use of this presentation had not translated into practice.
The hand therapists are using True Active Movement for their flexor tendon repairs and good gains in management of complex flexor tendon cases is being made since my last visit in 2016.
In 2016 the hand therapist had learned from Dr. D. Lalonde how to use the pencil test to determine if relative motion splinting (RMS) could be used to treat hand pain. At that time we practice fabricating RMS from donated material and had discussions about what materials may be more sustainable for the site. At this visit there was still no solution for sustainable splinting, so we practiced fabricating RMS from duct tape. Several RMS from duct tape were made for clients who presented with hand pain that had a positive pencil test result. Again, I believe this is a skills that will require follow-up in future visits as it is new and not yet fully integrated into practice.
A large hard drive (2TB) was purchased with the Vargas funds and presentations and pdf journal articles were uploaded to it. A substantial amount of this was focused on CRPS/GMI. Other pdfs and presentations about true active movement for flexor tendon repairs and the use of relative motion splinting in practice were uploaded. During this writer’s onsite visit in 2016 I presented a powerpoint presentation on GMI and another on peripheral nerve injuries to the physiotherapy Dept. Both of these were uploaded to the hard drive. During this visit a talk about quick tips and tricks for a hand therapist was presented to the physiotherapy Dept. Two wall posters of upper extremity (particularly hand and wrist) for patient education were also donated to the Dept.
Progress is happening in Kumasi, Ghana at the KATH hand therapy site. Communication with the surgeons is very good, formation of other interdisciplinary teams is lagging but physicians are asking and supportive of increased communication now that they see how well the plastic surgery team is functioning. The hand therapists are developing certain clinical skill sets. They are developing good skills in wound care and tendon management. They are comfortable advocating for earlier referrals for fracture cases. Thank you for the opportunity for this return trip. I hope to continue my outreach efforts.
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Reserve Commander Receives Humanitarian Award
Dr. Miguel Pirela-Cruz
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Longtime AAHS member Dr. Miguel Pirela-Cruz was honored as the Hand Association’s 2020 Humanitarian Award recipient at the January meeting in Ft. Lauderdale for living a life of putting service before self through his work with Guatemala Healing Hands Foundation and in his military service. Dr. Cruz was again recognized through a publication issued by the Dobbins Air Reserve Base. Congratulations and thank you, Dr. Pirela-Cruz!
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Share Your Articles from HAND
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Did you know that you can send links of interesting HAND articles to your friends, colleagues, and residents even if they don’t have a subscription to HAND? The following power point will guide you through these steps.
Access Sharing and e-Reacher on SAGE Journals
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Reserve Commander Receives Humanitarian Award
Dr. Miguel Pirela-Cruz
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Longtime AAHS member Dr. Miguel Pirela-Cruz was honored as the Hand Association’s 2020 Humanitarian Award recipient at the January meeting in Ft. Lauderdale for living a life of putting service before self through his work with Guatemala Healing Hands Foundation and in his military service. Dr. Cruz was again recognized through a publication issued by the Dobbins Air Reserve Base. Congratulations and thank you, Dr. Pirela-Cruz!
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Share Your Articles from HAND
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Did you know that you can send links of interesting HAND articles to your friends, colleagues, and residents even if they don’t have a subscription to HAND? The following power point will guide you through these steps.
Access Sharing and e-Reacher on SAGE Journals
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A Letter from the Editor
John Fowler, MD
Editor, Hand Association News
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With spring upon us, we enter a season of uncertainty. The novel coronavirus has disrupted the global economy, led to the cancellations of major conferences, and even resulted in universities transitioning to online classes. We have witnessed the stockpiling of toilet paper and disinfectant wipes. Stores are completely sold out of hand sanitizer and hospitals have been forced to deal with a shortage of facemasks. The fear of the impending pandemic has and will continue to affect our daily lives.
In these uncertain times, the field of hand surgery holds in interesting place. We are very rarely involved in life or death situations. Most of what we do is focused on improving the quality of life of our patients rather than saving it. There are serious discussions at my institution and many others about whether it is appropriate to continue performing elective surgeries and seeing patients in the office for non-traumatic/non-urgent hand and upper extremity conditions. This situation is very fluid and even as I write this, we are unsure what the next weeks and months may bring. My sincere hope is that we can look back on this letter and laugh about how silly it was that we have restricted the gathering of large groups and considered pausing elective treatments. Time will tell.
Whenever these types of events occur, it always reminds me of just how short and precious life really is. It makes me want to hug my wife and kids a little more tightly and cherish the moments that we have together as one never knows what tomorrow may bring. I hope that everyone who reads this remains safe and healthy.
Sincerely,
John Fowler, MD
Important Information
