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Live Surgery Tuesday - Thumb Scope (Basal Joint) #arthroscopy #orthopedics
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Live Surgery Tuesday - Thumb Scope (Basal Joint) #arthroscopy #orthopedics
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T00H16M31S
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https://cadmoreoriginalmedia.blob.core.windows.net/e2c50148-3ab5-439e-ba44-db861256d71a/Live Surgery Tuesday _ Thumb Scope (basal joint) arthroscop.mp4?sv=2019-02-02&sr=c&sig=23wsjeRoLb0qsZuc%2Bv22Jr0h68mz6AplVShgEPYiN8g%3D&st=2024-11-27T04%3A07%3A20Z&se=2024-11-27T06%3A12%3A20Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
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Language: EN.
Segment:0 .
Dr Badia here with #live surgery Tuesday. We have a manual worker. You see a big, big, heavy hand. He had a work injury some months ago and he's had persistent pain at the base of the thumb. X-rays are relatively normal, but in my experience, these folks have a ligament injury and there's really no way to diagnosis. MRIs are a waste of time and money, frankly.
So once conservative treatments fail, so I'm going to put the camera in and we will see what we have. Lights off? Yep so that's a bubble. So right away I can see this is cellulitis. So all that inflammation there. See, there's no there's no arthritis. You look at that the joints and its not pretty.
That looks I have a million patients who would love to have a joint like this. OK all right. And for the hand surgeons, this is the volar oblique ligament. You can see it going this way. And now we're going to look this way. And we're seeing even more cellulitis and some loosening of the ligament. So we're going to do is probably tighten that up.
All right. So two little holes. We're going to resolve this guy's problem. So let's get an 18 gauge. Now we're going to create another portal. There are so many things that go a little bit more this.
So this is almost a DR portal which was described by my colleague Orellana about 15 years ago. So a lot of what I'm doing is not totally new, but it is still a technology that's really underutilized for reasons that are a little unclear to me. But that's for another discussion. OK so.
So this is a 2 millimeter saber. [inaudible] Yeah a little faster would be good. But I'm going to take my first picture because I want to show the patient. But in my experience, the most important part is once I do this single vector, the removal of the inflamed synovial that I tighten it and it will have him in a cast for a few weeks just to let these ligaments tighten a little bit.
Then they'll do a little bit of hand therapy and that should be it. Doctor, if you could explain what each portal, what's going on in each portal with the tools that you're holding. It's a 1.9 millimeter camera, so it's not something going to hear about much, really. Only no pun intended, but only a handful of my colleagues really, I think, do a lot with that small camera.
I think there's a lot of potential. I've been doing it for 25 years, so it's not new, but for whatever reason, still not a commonly done procedure. But that is a small camera in there. It's a 30 degree camera. So if I want to look the other way, I'll swivel the light source, which we'll do in a moment. You see, every time I put suction, you see how that moves?
That's that those ligaments are too loose. So basically what you had is when you had the injury, you had, like, a partial tear of these ligaments. Just think about, like, a bad ankle sprain. And so ankle sprain, sometimes you need to do something more than just, you know, just crutches and sometimes you have to do. And in this case, we tried conservative treatment, but he's continued that pain.
So this is a relatively really atraumatic, simple way to diagnose the problem. So because sometimes I put the scope in and it's much worse. So this is really [inaudible] See, I'm removing a lot of this synovial now. We're going to tighten it up right now and then we're going to probably change portals because I want to see. Yeah, I'll see right there.
This is the dorsal radial ligament and that looks kind of raggy. So you're going to change portals in a moment. And then we'll do that. Then we can do to shrink itself. If you could elaborate, Dr. Badia on why you think an MRI is not necessary for this? Well, for one, it's a very small joint. A lot of times, MRIs are ordered by well-meaning colleagues who don't know a lot about the trapeziometacarpal joint.
So, you know, you think that the test is going to spit out an answer as to why they have pain. And it just doesn't it just doesn't happen. It's not you know, we have an MRI right in our center. All right. So literally 20 feet away from where I saw him. And it didn't even come into my mind. But, you know, honestly, this is one of the multiple issues that our health care system is.
The people who should be ordering studies are the ones who are actually going to do the treatment. And that's something that doesn't happen. Just like I don't usually order a cervical MRI because I'd rather my spine specialist colleague make that decision. Let's do our reps since we're on the side and then we'll change course. So really what you need, obviously you always need a plain X-ray because that will show you, some arthritis.
But what you really need is a physical examination by someone experienced in this particular area. That's really, it's like anything else in medicine. OK so now this is the radio frequency shrinkage probe. So no one should be too aggressive with this again.
So some of the comments are making are for my colleagues. You see, I'm just touching the tissue. Now, now I'm going to do another strike and I call this a striking technique. I've described it in the papers I've written. The reason being is you want to make sure that in between that area, this has good blood supply for healing. You don't want to paint the whole capsule there already.
It looks better, tighter. So with this. We had a few patients comment last week about the biopro procedure. Yeah. And another alternative. Can you elaborate about how this would benefit a patient with basal joint arthritis? Well, arthroscopy is good for an earlier stage of arthritis, so based on the X ray, but I also do it based on their age.
So I've seen a lot of 40-year-olds with pain at the base of the thumb, no injury but I don't necessarily want to go ahead do it with a prosthesis with them. So arthroscopy is a great and that's something I did a lot more of. But the implant in my experience now has the recovery so much faster that depending on our activities, these guys are manual workers.
So I certainly, you know, middle aged guy, I don't want to put the prothesis in them. And in this case, that would never be indicated because really the joint looks very good. But look how much tighter everything looks. When we got in there, the whole capsule was just redundant. All right. So I'm going to take a picture of that to show him important for the patient to understand.
That's a really good view right there. Your ligaments there. Paul Bebinger from Vermont, the resident with me. He was at the Mayo Clinic with Dick Berger, who has sadly has since passed away. But he's one of the people who really described this arthroscopy and Paul, in a research study at the Mayo clinic, described no less than 12 ligaments, I think 17.
So a lot of these ligaments have names. So obviously. But look, this looks very good. All right. So here's a really good view.
But look, see, here's this redundant right there. You can see this part of the joint. So shaver, please. Yeah so Kate knows to grab the scope because sometimes I need two hands. So believe it or not, these small joint arthroscopies are kind of a two person surgery. Now can you explain what you're shaving away?
This is just the inflamed ulnar. So this is really what causes the pain. This is what we call synovitis. So you see this in any joint, whether it be the knee, you have a big swollen knee after an injury, that's the synovium which secretes the synovial fluid, which is a lubricating fluid in a joint. The synovium can get very inflamed and secretes a variety of factors, what we call cytokines.
Not to get too technical, but that is what's responsible for the brain recognizing it as pain. So what I'm going to do is just can see I'm already see right below me already. Most of the synovitis is resected already. Now I had this patient come in at the time of his injury. Would you have recommended any other minimally invasive or non surgical?
Depends on how significant his symptoms were in all. Yes, the problem is many times these patients are referred to the specialist very late. And this is, anybody who knows me knows I've been battling on this because it's just, the misconception is that you're saving money by, but the reality is that the specialists often order less tests. And because of experience in that area, they understand a little bit more the treatment.
So if I had seen them early on, I might have simply put them in a cast, a spika cast. And let the ligaments heal. But that's usually not the case. They might be given one of these splints, you see, but the splint maybe doesn't even doesn't really immobilize the base of the thumb very well. Sometimes we can do injections of the biologic growth factors to PRP.
Platelet rich plasma is not for me, not ideal here because it's too small a joint. So I use an off the shelf product. There's a few of them on the market. I use one called CPM and we put it in with a little anesthetic under fluoroscopy. So I'm sure I'm in perfectly in the joint already. This looks better. And you can see more trans illumination.
When we first got in there, you only saw a little bit of orange. The whole joints lit up because I removed the inflamed lining. So this is a technology we kind of, you know, as usual, we steal ideas from the knee guys because its a big joint. And, you know, a lot of the industry in orthopedics initially is directed many times at knee problems because they're very common.
But I actually helped design these probes over 20 years ago. But let me ask you if I got any royalties because I'm not very smart about that stuff. [Spanish] What do you think Kate?
We're good. [Spanish] Or in English.
Ask me a question. Thank you.
Segment:0 .
Dr Badia here with #live surgery Tuesday. We have a manual worker. You see a big, big, heavy hand. He had a work injury some months ago and he's had persistent pain at the base of the thumb. X-rays are relatively normal, but in my experience, these folks have a ligament injury and there's really no way to diagnosis. MRIs are a waste of time and money, frankly.
So once conservative treatments fail, so I'm going to put the camera in and we will see what we have. Lights off? Yep so that's a bubble. So right away I can see this is cellulitis. So all that inflammation there. See, there's no there's no arthritis. You look at that the joints and its not pretty.
That looks I have a million patients who would love to have a joint like this. OK all right. And for the hand surgeons, this is the volar oblique ligament. You can see it going this way. And now we're going to look this way. And we're seeing even more cellulitis and some loosening of the ligament. So we're going to do is probably tighten that up.
All right. So two little holes. We're going to resolve this guy's problem. So let's get an 18 gauge. Now we're going to create another portal. There are so many things that go a little bit more this.
So this is almost a DR portal which was described by my colleague Orellana about 15 years ago. So a lot of what I'm doing is not totally new, but it is still a technology that's really underutilized for reasons that are a little unclear to me. But that's for another discussion. OK so.
So this is a 2 millimeter saber. [inaudible] Yeah a little faster would be good. But I'm going to take my first picture because I want to show the patient. But in my experience, the most important part is once I do this single vector, the removal of the inflamed synovial that I tighten it and it will have him in a cast for a few weeks just to let these ligaments tighten a little bit.
Then they'll do a little bit of hand therapy and that should be it. Doctor, if you could explain what each portal, what's going on in each portal with the tools that you're holding. It's a 1.9 millimeter camera, so it's not something going to hear about much, really. Only no pun intended, but only a handful of my colleagues really, I think, do a lot with that small camera.
I think there's a lot of potential. I've been doing it for 25 years, so it's not new, but for whatever reason, still not a commonly done procedure. But that is a small camera in there. It's a 30 degree camera. So if I want to look the other way, I'll swivel the light source, which we'll do in a moment. You see, every time I put suction, you see how that moves?
That's that those ligaments are too loose. So basically what you had is when you had the injury, you had, like, a partial tear of these ligaments. Just think about, like, a bad ankle sprain. And so ankle sprain, sometimes you need to do something more than just, you know, just crutches and sometimes you have to do. And in this case, we tried conservative treatment, but he's continued that pain.
So this is a relatively really atraumatic, simple way to diagnose the problem. So because sometimes I put the scope in and it's much worse. So this is really [inaudible] See, I'm removing a lot of this synovial now. We're going to tighten it up right now and then we're going to probably change portals because I want to see. Yeah, I'll see right there.
This is the dorsal radial ligament and that looks kind of raggy. So you're going to change portals in a moment. And then we'll do that. Then we can do to shrink itself. If you could elaborate, Dr. Badia on why you think an MRI is not necessary for this? Well, for one, it's a very small joint. A lot of times, MRIs are ordered by well-meaning colleagues who don't know a lot about the trapeziometacarpal joint.
So, you know, you think that the test is going to spit out an answer as to why they have pain. And it just doesn't it just doesn't happen. It's not you know, we have an MRI right in our center. All right. So literally 20 feet away from where I saw him. And it didn't even come into my mind. But, you know, honestly, this is one of the multiple issues that our health care system is.
The people who should be ordering studies are the ones who are actually going to do the treatment. And that's something that doesn't happen. Just like I don't usually order a cervical MRI because I'd rather my spine specialist colleague make that decision. Let's do our reps since we're on the side and then we'll change course. So really what you need, obviously you always need a plain X-ray because that will show you, some arthritis.
But what you really need is a physical examination by someone experienced in this particular area. That's really, it's like anything else in medicine. OK so now this is the radio frequency shrinkage probe. So no one should be too aggressive with this again.
So some of the comments are making are for my colleagues. You see, I'm just touching the tissue. Now, now I'm going to do another strike and I call this a striking technique. I've described it in the papers I've written. The reason being is you want to make sure that in between that area, this has good blood supply for healing. You don't want to paint the whole capsule there already.
It looks better, tighter. So with this. We had a few patients comment last week about the biopro procedure. Yeah. And another alternative. Can you elaborate about how this would benefit a patient with basal joint arthritis? Well, arthroscopy is good for an earlier stage of arthritis, so based on the X ray, but I also do it based on their age.
So I've seen a lot of 40-year-olds with pain at the base of the thumb, no injury but I don't necessarily want to go ahead do it with a prosthesis with them. So arthroscopy is a great and that's something I did a lot more of. But the implant in my experience now has the recovery so much faster that depending on our activities, these guys are manual workers.
So I certainly, you know, middle aged guy, I don't want to put the prothesis in them. And in this case, that would never be indicated because really the joint looks very good. But look how much tighter everything looks. When we got in there, the whole capsule was just redundant. All right. So I'm going to take a picture of that to show him important for the patient to understand.
That's a really good view right there. Your ligaments there. Paul Bebinger from Vermont, the resident with me. He was at the Mayo Clinic with Dick Berger, who has sadly has since passed away. But he's one of the people who really described this arthroscopy and Paul, in a research study at the Mayo clinic, described no less than 12 ligaments, I think 17.
So a lot of these ligaments have names. So obviously. But look, this looks very good. All right. So here's a really good view.
But look, see, here's this redundant right there. You can see this part of the joint. So shaver, please. Yeah so Kate knows to grab the scope because sometimes I need two hands. So believe it or not, these small joint arthroscopies are kind of a two person surgery. Now can you explain what you're shaving away?
This is just the inflamed ulnar. So this is really what causes the pain. This is what we call synovitis. So you see this in any joint, whether it be the knee, you have a big swollen knee after an injury, that's the synovium which secretes the synovial fluid, which is a lubricating fluid in a joint. The synovium can get very inflamed and secretes a variety of factors, what we call cytokines.
Not to get too technical, but that is what's responsible for the brain recognizing it as pain. So what I'm going to do is just can see I'm already see right below me already. Most of the synovitis is resected already. Now I had this patient come in at the time of his injury. Would you have recommended any other minimally invasive or non surgical?
Depends on how significant his symptoms were in all. Yes, the problem is many times these patients are referred to the specialist very late. And this is, anybody who knows me knows I've been battling on this because it's just, the misconception is that you're saving money by, but the reality is that the specialists often order less tests. And because of experience in that area, they understand a little bit more the treatment.
So if I had seen them early on, I might have simply put them in a cast, a spika cast. And let the ligaments heal. But that's usually not the case. They might be given one of these splints, you see, but the splint maybe doesn't even doesn't really immobilize the base of the thumb very well. Sometimes we can do injections of the biologic growth factors to PRP.
Platelet rich plasma is not for me, not ideal here because it's too small a joint. So I use an off the shelf product. There's a few of them on the market. I use one called CPM and we put it in with a little anesthetic under fluoroscopy. So I'm sure I'm in perfectly in the joint already. This looks better. And you can see more trans illumination.
When we first got in there, you only saw a little bit of orange. The whole joints lit up because I removed the inflamed lining. So this is a technology we kind of, you know, as usual, we steal ideas from the knee guys because its a big joint. And, you know, a lot of the industry in orthopedics initially is directed many times at knee problems because they're very common.
But I actually helped design these probes over 20 years ago. But let me ask you if I got any royalties because I'm not very smart about that stuff. [Spanish] What do you think Kate?
We're good. [Spanish] Or in English.
Ask me a question. Thank you.
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