Summer 2021

A Message from the President, Dr. Nash Naam

Nash Naam, MD
Nash Naam, MD
AAHS President

I hope all our members are doing well, staying safe, and enjoying the end of summer. As kids go back to school, the new academic year begins, and the Delta variant continues to impact our country, change is once again in the air. As a community I know we will weather these changes with grace and fortitude, and together come out stronger yet again.

Your Hand Association Board of Directors was able to meet in-person in July for a very productive midyear meeting. I have summarized the major initiatives below and plan to share more with you as programs develop.

  • The AAHS 2022 Annual Meeting planned for this coming January is moving forward in-person for Carlsbad, California. The Hand Association leadership is working to ensure that COVID-19 safety measures are in place to keep our members and attendees safe and comfortable while being able to participate in an outstanding scientific and social program organized by Drs. Julie Adams and Mark Rekant, Cindy Ivy, OTR/L, CHT, and Vanessa Smith, PA-C. The preliminary program as well as registration and housing will be available this month. As a reminder, spouses, guests and children of AAHS members can attend the meeting, including all social events, for free!
  • We have learned a lot over the last eighteen months about educational vehicles for our community as well as different types of education that may be of value in today's world. There are a number of new educational programs the Hand Association will put in place over the course of the next several months which will provide new CME opportunities to our members, including trainees, young members, therapists and APPs, as well as practical education we may be able to apply as we work for balance in our lives. More announcements to be made soon!
  • The Board of Directors continues to examine AAHS member value and wants to know specifically what Hand Association members want from the AAHS. When you receive a survey in the near future asking you what you would like from your AAHS membership, please take a few minutes to share your thoughts. Your candid feedback is important!
  • In early September the AAHS will launch a Travel Scholarship program to fund the travel of residents, fellows, and member of the military to attend the 2022 Annual Meeting! Eligible candidates will need to apply via application. For members who would like to contribution to this program and make a difference in the career path of the promising class of upcoming hand surgeons, there will be an opportunity to donate! The link to donate will be shared with the membership soon.
  • HAND, the journal of the AAHS, is doing incredibly well with significant growth and an amazing number of submissions this year. The quality of our journal is strong, and I encourage all members of our community to submit their best work for publication in HAND. HAND strives to provide critical and constructive feedback to authors, which is important for author development. In addition, the first HAND in Focus, HAND's journal club, session was held earlier this week and was a wonderful success with about 100 participants, lively discussion, and take home messages from featured authors. HAND in Focus is a great forum to dive into some of the top articles from our journal and I hope our members and prospective members will participate in future sessions.
  • Our DEI Committee, led by Dr. Miguel Pirela-Cruz, will share the AAHS statement on diversity, equity and inclusion they have assembled with the membership soon. This committee has been extremely thoughtful in their work, and I applaud them for taking this charge on in such a meaningful way. Over the next several months other programs born from the work of the DEI Committee will be shared with the membership and through social media. These programs are designed to expand our minds and educate our community.
In closing, the American Association for Hand Surgery remains strong and our activities continue to expand thanks to our fantastic membership and the congenial culture our members has developed for our organization. I am blessed to be able to serve as your President. I hope to see many of you at the ASSH Annual Meeting in San Francisco in October.


Nash Naam, MD
President, American Association for Hand Surgery




From the Editor's Desk

John Fowler, MD
John Fowler, MD
Editor, Hand Association News
We enter another season of uncertainty. The COVID-19 delta variant has become the dominant strain in the United States and elsewhere. This has resulted in a “surge” in cases, mostly in the unvaccinated. The “return to normal” that we experienced in the summer has started to fade with mask mandates and restrictions in travel returning. It is my sincere hope that the Annual Meeting can be held in person this coming January.

As mentioned in my last letter, the Newsletter has undergone some exciting changes this year. We have added content and Junior Editors to improve the newsletter experience. I would invite you to reach out to the AAHS staff if you have suggestions for additional content that would be of interest to members. One of the “new” features is a review of a recent article published in HAND, by Dr. Jonathan Lundy. There is a short review and link to the recent AAHS distal radius webinar. We are continuing the popular “Meet a AAHS Member” with Dr. Amber Leis. The Therapist Corner compares Early Active Motion to Passive Motion protocol for flexor tendon rehabilitation. Dr. Noah Raizman reviews coding controversies regarding surgical billing for CMC arthroplasty. We also have a message from our President, Dr. Nash Naam and Dr. Jesse Kaplan gives us the “local flavor” for the Annual Meeting in Carlsbad, CA.

As you can see, we have some interesting content should appeal to a wide range of members. I hope you enjoy it and hope to see you in Carlsbad this coming January.

Sincerely,

John Fowler, MD
John Fowler, MD
Editor, Hand Association News




Meet a Member! Meet Dr. Amber Leis

Dr. Amber Leis

In this Summer edition of the Hand Association News issue, we are continuing the “Ask a Member” column, designed to highlight one of our many wonderful AAHS members. It is an opportunity to learn more about our colleagues outside of medicine and to help us connect as a national and global community. Members should feel free to write in to nominate interviewees and suggest questions.

Please meet Dr. Amber Leis! Interview by Dr. Jennifer Kargal.

Biography:
Dr. Amber Leis is an associate professor in the department of plastic surgery at UC Irvine in Irvine, California. She has been a member of the American Association for Hand Surgery since 2017. She completed her medical school training at Johns Hopkins University and her residency training in plastic surgery at Loma Linda University. She then completed an orthopedic hand surgery fellowship at Keck School of Medicine of USC. As a board-certified plastic surgeon and hand surgeon, her scope of practice includes aesthetic and reconstructive surgery and pediatric hand and brachial plexus surgery. In addition to a busy clinical practice, Dr. Leis serves as the director of the division of hand surgery and is the residency program director for UC Irvine’s integrated plastic surgery residency program.

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Ask an Expert!


Dr. Noah Raizman

After the Spring 2021 issue of Hand Association News was released we received the following questions which we referred to coding expert, AAHS member Dr. Noah Raizman.

Ask the Expert Query: Coding for CMC arthroplasty. What codes do you use for LRTI, suspensionplasty, tightrope, endobutton, etc. Can you bill for a deQuervain release? Is dorsal capsulodesis a code you should use? Is there an added code for suture suspension other than just trapeziectomy? And any other general thoughts on it.

Ask the Expert Query: Hello, We have a scenario that I was wondering if you would weigh in on. 26356 and 26502 were both performed. 26502 is a "separate procedure" and should not be billed when done with another procedure on the same anatomical location. The tendon pully was not cut to repair the tendon flexor, it was torn due to the injury. Thank you!

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Around the Hand Table: Distal Radius Fractures


Dr. Rachel Guest

By Rachel Guest, MD

For those who remember Around the Hand Table from past newsletters, I am happy to announce we have revived and modernized this column! This issue we are pleased to again feature the AAHS Distal Radius Fractures webinar which originally aired May 17, 2020. Watch this entire webinar or brush up on specific topics related to the treatment of distal radius fractures.

Distal radius fractures are common pathologies encountered by the hand surgeon. Management of these fractures can be complicated even for experienced surgeons, especially when considering patient age, medical comorbidities, and complexity of the fracture pattern. In the AAHS Distal Radius Fractures webinar featuring Drs. Bozentka, Gaston, Osterman, Pensy, and Jupiter, distal radius fractures, including evaluation and radiographic assessment, treatment options, and management of malunions, are discussed. The articles below complement the webinar, highlighting the impact of a growing elderly population on treatment options and outcomes, and provide further insights into management of malunion following closed or open management of distal radius fractures.

Articles:

  1. Evans BT, Jupiter JB. Best approaches in distal radius fracture malunions. Curr Rev Musculoskelet Med. 2019;12:198-203.
  2. Levin LS, Rozell JC, Pulos N. Distal radius fractures in the elderly. J Am Acad Orthop Surg. 2017;25(3):179-87.



Therapist Perspective

Rehabilitation of Flexor Tendons: Early active motion vs Kleinert/Modified Duran

By Rose Luciano, MS, OTR/L

Post-operative management of flexor tendons is one of the most challenging areas of treatment for the hand therapist. Obtaining an excellent or good (1) result requires a delicate balance between facilitating tendon excursion and protecting the repair. An optimal response is dependent on many factors, such as, a) the mechanism of injury, b) the surgery, c) patient compliance, d) individual healing process of the tendon and wound, and e) the therapist’s ability to evaluate and adjust treatment according to the tendon’s response to therapy (2). The goals for the therapists are to a) protect the repair, b) regain tendon excursion and interphalangeal joint motion without gapping or rupturing the suture. However, this is a difficult task due to the normal wound healing process which may result in the development of moderate to severe edema, adhesions, joint stiffness and interphalangeal joint contracture all of which can impede tendon excursion and lead to rupture if not controlled. Currently, there are 3 types of protocols in the literature that are utilized as guidelines in the treatment of flexor tendons: 1) complete immobilization, 2) early active motion (EAM) which can be either partial active flexion of the interphalangeal joints or “place and hold” combined with synergistic movement of the wrist; and 3) early passive motion (EPM) which consists of the Kleinert or Modified Duran regime respectively. This article will focus on the current key concepts of EAM versus EPM. For the purposes of clarity, EAM is defined as any type of active motion following a flexor tendon repair initiated prior to 5-6 days post-surgery.

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Towards validating opioid prescribing guidelines to assist hand surgeons reign in their role in opioid abuse and divergence. Less prescribed opioids beget efficacy and satisfaction with minimal refill requests.

An Article Review of Adalbert JR, Ilyas AM. Implementing prescribing guidelines for upper extremity orthopedic procedures:
a prospective analysis of postoperative opioid consumption and satisfaction. Hand 2021;16:491-7

Jonathan B. Lundy, MD, FACS

By Jonathan B. Lundy, MD, FACS
Hand Surgeon, US Army Institute of Surgical Research

Our goal with this and the previous issue’s article review has been to focus on potential solutions that hand surgeons can implement to curb the abuse and diversion of opioids. This issue’s review discusses the recent report by Adalbert and Ilyas on implementing opioid prescribing guidelines for outpatient hand surgical procedures. (1) There is a lack of awareness on the appropriate number of opioids to prescribe and of the amount patients actually take (2). The purpose of the authors’ study was to prospectively evaluate postoperative opioid consumption for upper extremity outpatient procedures. Prescribing was based on a more concise modification of general guidelines developed by the authors’ institution. These guidelines were a product of a previous evaluation of opioid prescription and consumption (Table 1). (3)

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Upcoming Webinars and Online Video Resources from AAHS

AAHS/AAOS CME Webinar: Peripheral Nerve Injuries - Management of Nerve Gaps
Monday, September 13, 2021, 8:00 PM Eastern (7:00 PM Central, 6:00 PM Mountain, 5:00 PM Pacific)

Nerve injuries are common upper extremity injuries facing Orthopaedic Surgeons, Hand Surgeons, and Plastic Surgeons. However, these injuries can be particularly challenging and controversial in the setting of a nerve injury with a gap not amenable to primary repair. Fortunately, a number of surgical options exist to manage nerve gaps but various patient, anatomic, and clinical variables need to be considered in deciding the optimal surgical strategy and post-surgical therapy. Our expert faculty will review the various surgical options including nerve autografts, allografts, conduits, and nerve transfers – with a particular focus on evidenced-based indications, surgical techniques, pearls and pitfalls, and post-surgical rehabilitation strategies. Moreover, strategies for nerve gaps for both digital nerves and mixed peripheral nerve will be discussed. Faculty: Moderator and Chair Asif Ilyas, MD, MBA; Kyle Eberlin, MD; Amy Moore, MD; Michael Rivlin, MD; Peter Tang, MD, MPH

This webinar is being hosted by the AAHS and the American Academy of Orthopaedic Surgeons (AAOS). All AAHS members, including orthopedic, general, and plastic surgeons, hand therapists, advanced practice providers, and trainees, are able to register for this webinar for free through the Academy platform. To ensure your complimentary rate as an AAHS member, please contact AAOS Customer Service at 1-800-626-6726 or +1-847-823-7186.


Learn About a Nonsurgical Treatment Option and Review Case Studies with Dupuytren’s Contracture Expert, Dr. Glenn Gaston
Tuesday, October 19, 2021, 8:00 to 9:30 PM Eastern Time

Join Endo Pharmaceuticals for a virtual clinical overview of Dupuytren’s contracture, including experienced perspective on the treatment procedure, patient consultation, and case studies. Attendees will also learn about Endo’s new Injection Simulator, developed to help you practice and improve your technique.
Presented by: Dr. Glenn Gaston

Registration will be available soon.


Visit the AAHS website for complimentary access to 18 outstanding webinar recordings for replay.



Local Flavor: What to do and see in Carlsbad, California in January 2022


Jesse Kaplan, MD, MBA
Welcome to San Diego! Feel free to insert your favorite Ron Burgundy quote from Weatherman. San Diego has the honor of hosting the AAHS Annual Meeting in January 2022. As a nearby Southern California native, I am excited to welcome you to Carlsbad, California.

Carlsbad is 1.5 hours south of Los Angeles and 30 minutes north of Downtown San Diego. Uniquely situated in Northern San Diego County, you get some of the best California has to offer without the crowds and congestion of the city. I hope you have a chance to enjoy the beach, sun, great food and amazing beer.

The Omni La Costa Hotel is located between Carlsbad and neighboring city Encinitas. Whether you want to enjoy the local spots or take a trip down to downtown San Diego, there is lots to do and see between courses or after we finish up for the day. Here are some fun activities to consider in the near-by area:

Beaches: San Diego has great beaches. The nearby Carlsbad state is a fun 5 mile stretch of beach with wide sand and fun waves. Nearby beaches are Terramar and South Ponto Beach which are a short drive from the hotel. For the surfers who would like to score a few winter waves or anyone looking like to give surfing a try, the closest surf breaks are Cardiff and Swami’s. You can also take a drive and a hike down to the famous Black’s Beach. There are fun breaks in Encinitas, Del Mar and La Jolla. If you drive north of Camp Pendleton and you can check out San Clemente and Trestles.

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Receive a 15% Discount on 2022 Annual Meeting Registration

Receive a 15% Discount on 2022 Annual Meeting Registration

The Hand Association’s leadership and Program Chairs are working to put together a stellar event to reunite the hand care community in January! How can you receive a 15% discount on 2022 Annual Meeting registration?

Recruit a friend or colleague to join AAHS this year! New members elected in 2021 and existing AAHS members who recruit a friend or colleague to join the Hand Association as a member will receive a 15% discount off 2022 Annual Meeting registration fees!



Share Your Articles from HAND

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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Helpful Links

Looking for a New Position?
13 Open Positions on the Job Board!

AAHS currently has 13 open positions on its Job Board, including opportunities for hand surgeons, orthopedic surgeons, peripheral nerve surgeons, reconstructive surgeons, and plastic surgeons across the country. Check them out!

Do you have a job or other opportunity that you would like to advertise to the AAHS community? Visit the AAHS Job Board to post your position today!