2 The OA Update

The OA Update 3

The OA Update is published by Oser-Bentley Custom Publishers, LLC, a division of Oser Communications Group, Inc., 1877 N. Kolb Road, Tucson, AZ 85715. Phone (520) 721-1300, fax (520) 721-6300, www.oser.com.Oser-Bentley Custom Publishers, LLC specializes in creating and publishing custom magazines. Editorial comments: Karrie Welborn, karrie_w@oser.com. Please call or fax for a new subscription, change of address,or single copy. This publication may not be reproduced in part or in whole without the express written permission of Oser-Bentley Custom Publishers, LLC. To advertise in an upcoming issue of this publication, pleasecontact us at (520) 306-2454 or (520) 721-1300 or visit us on the Web at www.oser-bentley.com. April 2010

6. Pre-Skiing Performance TrainingGet ready for next season now!Are you planning on skiing next winter?Know how to prepare and train to have the best season ever! Michael Mullin, ATC, LAT explains it all.

8. Plantar FasciitisWhy does my foot hurt?Kristina Kramer, PA-C explains whatplantar fasciitis is, why it occurs and how it can be treated.

10.Trigger FingerWhat it is. Why it happens.The cause, symptoms and treatment for the condition known as trigger finger. Sacha Matthews, MD explains it all.

12. Leading the WayOA Surgery Center celebrates 20 yearsA retrospective on how it all began, wherethe Orthopaedic Surgery Center (OSC)is now, and what’s in the future in thisaward-winning OSC.

19. Holding HandsThe specialty of hand therapyStacey L. Doyon, OTR/L, CHT explainshand therapy services.

FEATURESIn This Issue

DEPARTMENTS 5. OA in Motion: What’s New? News and notes on people, places and happenings in the organization.

4 The OA Update

Opening RemarksOA recently celebrated the 20th anniversary of the Orthopaedic Surgery Center, which wasoriginally established in October of 1989. In this issue, we share some of the highlights andaccomplishments in those 20 years. So much has happened over these years, and OA continuesto do its best to respond and adapt to the needs of our patients and the ever changing faceof healthcare.

We hope you find this issue informative and helpful, and we welcome any suggestions forfuture publications. We’ve already heard from some of you and are appreciative of yourcomments and feedback!

Sincerely,The Physicians at OA Centers for Orthopaedics

Cover photo credits: Linda Ruterbories, MS, ANP (Director of the OSC)

OA is the premier orthopaedic practice in Maine.Our 23 highly specialized physicians are experi-enced in the latest techniques and innovations. OAspecialty centers include sports medicine; handsurgery; joint reconstruction of the hip, knee andshoulder; foot and ankle surgery; and complex frac-ture treatment. OA—Experience in motion!

The information contained in this publication is notintended to replace a physician’s professionalassessment. Please consult your physician on mat-ters related to your personal health.

OA Centers for Orthopaedics33 Sewall St.Portland, Maine 04102(207) 828-2100 • (207) 828-2190 faxinfo@orthoassociates.com

John Wipfler Chief Executive Officer

Satellite Locations:

Saco Office15 Lund RoadSaco, ME 04072(207) 282-4210

Windham Office4A Commons Ave. Rte. 302Windham, ME 04062(207) 893-1738

Specialty CentersJoint Replacement CenterOrthopaedic Trauma CenterHand CenterFoot and Ankle CenterSports Medicine CenterSpine CenterMRI CenterOrthopaedic Surgery CenterPhysical Therapy CenterPerformance Center

The OA Update 5

OA in MotionWelcome!Alison Geer, PA-C, joined the Sports MedicineCenter as Dr. Ben Huffard’s physician assistant.Catherine Morrill, OT, CHT, joined thePhysical Therapy Center, working as a certifiedhand therapist based out of OA’s Saco location.Audrey Mackenzie, AT-C, is now working asOA’s liaison to other area certified athletictrainers while continuing in her current role asthe athletic trainer for Portland High School.

The OA ExperienceOur mission of striving to deliver excellence inorthopaedic care can only be achieved throughthe combined efforts of knowledgeable anddedicated employees along with the physicians.OA is pleased to report that, in addition to highpatient satisfaction, we also enjoy high employeesatisfaction. The national healthcare staffturnover rate is 21 percent according toMGMA, while OA is well below that averagewith a 10 percent turnover rate.

Portland High School presents OA with the 2009 Ganley AwardThe 2009 Robert Ganley Award was presentedto OA as a result of its effort and dedication tothe football community. Dr. Douglas Brown

and Dr. William Heinz accepted the award onbehalf of OA.

Dr. Brown and the Traveling Fellowship ProgramThe traveling fellowship program is an annualscientific and cultural exchange amongorthopaedic sports medicine physicians inNorth America, Europe, Asia-Pacific and LatinAmerica. Three fellows are selected to visitforeign sports medicine centers for four weeks,and are accompanied by a “Godparent,” a well-known senior orthopaedic sports medicinespecialist selected by the president of thenational sports medicine organization sendingthe fellows. Dr. Douglas Brown was privilegedto be named as “Godfather” and to travel withthese fellows to Japan, China, South Korea,Singapore and Taiwan.

New Programs and HoursDuring the past fall sports season, OA offeredweekend hours as an alternative to emergencyroom care to recreational and school athleteswho sustained orthopaedic injuries. In addition,MRI services are also being offered on Saturdaymornings as part of our commitment to meetingour patients’ needs effectively and conveniently.

OA as a Community PartnerOA Denim Days for Charity: Staff can weardenim one Friday each month by making acharitable donation. OA has raised more than$1,800 for seven charities through this program,with a focus on local organizations: ArthritisFoundation, Preble Street Resource Center,Barbara Bush Children’s Hospital, LifeFlight ofMaine, United Way of Greater Portland, RonaldMcDonald House of Portland and the Centerfor Grieving Children.

In addition, OA’s Dr. Matt Camuso, LindaRuterbories, MS, ANP (Director of the OSC)and Joanne Leblanc, RN, joined other medicalpersonnel in collaboration with Konbit Sante toprovide much needed medical supplies and

surgical care to earthquake victims in Haiti.While much was accomplished in their weeklongtrip, there is more work to be done. OA hopes tosend additional support in the future months.

Partnership with Maine Premier SoccerOA has been named as an official MPSPortland Phoenix Premier Team Partner.Athletes will be participating in the programsoffered through the Performance Center,while OA physicians will provide medicalcoverage for the Portland Phoenix, a reserveprogram for the professional team TampaBay Rowdies (of the North).

The Maine Concussion InitiativeIn our last issue of The OA Update, Dr.Lucien Ouellette shared information aboutconcussion injuries. Dr. William Heinz ofOA, along with Dr. Paul Berkner and Dr. JoeAtkins, both of Colby College, founded theMaine Concussion Management Initiativein 2009. The goal of this program is toenhance the health and safety of Maine highschool athletes by educating medicalpractitioners and school administratorsabout the dangers of traumatic brain injuryand the importance of consistent concussionmanagement. The initiative is committed tomaking computerized cognitive testingavailable to all high schools in Maine andwill begin rolling out this program with25 high schools in the first year.

Dr. Matt Camuso and Dr. Pierre Louis discuss theinstruments OA brought to Haiti.

Joanne Leblanc, RN with a Haitian child

6 The OA Update

If your winter sports activities were not aspolished in 2010 as you would prefer, startnow to prepare for winter 2011 by using

performance training techniques. Activities suchas snowshoeing, ice skating, snowboarding,nordic, alpine and telemark skiing are all

popular in Maine. While snowshoeing, nordicskiing and ice skating are activities that also havea fitness benefit, some of the faster sports such

Pre-Skiing Performance TrainingBy Michael J. Mullin, ATC, LAT

Fig.1

as snowboarding, alpine and telemark skiingdemand more dynamic strength, balance andtrunk control in order for an individual toparticipate in the most enjoyable and safest way.

In order to prepare for these types ofsports, it is best to do some preparation to getyourself in top condition. Alpine and telemarkskiing, in particular, require a strong basewhich means incorporating more than just aregular exercise program. Specific exercises,designed in a sequence, should be institutedwhere progression is gradual and shouldaddress the main components of the sport:flexibility and mobility, cardiovascular and coreconditioning, strength and balance training,and power and endurance development.

Mobility and flexibility top the listbecause you cannot train for strength if youcannot get into the positions needed.Dynamic flexibility is a great way to introducemovement-based stretches that increase tissueand joint movement while at the same timeactivating muscles for activity. This can bedone through a self-stretching program (referto OA Update, Vol. 1, Issue 1, Page 5, atwww.orthoassociates.com/_pdfs/OA_Update_Vol1_Iss1.pdf ) or introducing a tai chi,yoga or Pilates class to learn other ways toimprove mobility.

Once you are able to get into a fairly deepsquat position with feet flat on the ground andthe body stable over the legs, then building thebase of cardiovascular and core conditioningtakes over. Regular activities such as cycling,elliptical and stair machines, brisk walking,running and inline skating are excellent choicesfor cardiovascular training. Incorporating coreconditioning exercises such as crunches, planks

The OA Update 7

with leg lifts, side planks, on-all-fours alternateleg and arm lifts while bringing the knee to theopposite elbow help develop a strong trunk andmidsection. Most exercises on a physioball arealso great for core conditioning.

Strength and balance training come next.Squatting and lunge-based exercises areexcellent strengthening programs. Performinga combination of both and adding medicineball rotations, pulling on sport cords, rotatingthe upper torso with or without weight,pressing a weight overhead or performing onan unstable surface, are all great options toincrease the challenge on the body.

Power and endurance development comeafter all the other factors have been addressed.The foundation has been built; it is time toincrease the challenge to the system byintroducing more jumping, bounding andaggressive resistance training. Plyometrics area good way to accomplish this by jumping onand off boxes, up and over objects—bothforward and backwards—as well as side-to-side. Holding onto resistance bands andperforming loading and jumping exercises areanother way to increase your power output.

Proper positioning over the skis isessential, in particular the pattern ofmovement the hips and pelvis should gothrough as the weight is transferred from oneski to the other. The ability to actively shiftthe pelvis back as you transition through yourpole plant from your uphill ski onto thedownhill ski is critical for proper turning andreducing risk for injury. Most people feel morecomfortable performing this on one sideversus the other. Use the following tests todetermine which side may be more restricted

or weaker. You can then use this informationto focus more on exercises into that position.

Ski Position Self-AssessmentDetermining your dominant side:Stand facing a table. Place your feet skiingdistance apart, pointing to the right at a 45degree angle with your left foot a little back ofthe right. This is mimicking a turn to the rightwhile skiing. Rest both hands lightly on thetabletop and let them slide forward as you slowlysquat down, shifting back through your hips.Let hands slide forward and try to avoid leaningback and hanging on with your hands. Keepyour weight evenly distributed between heels andtoes and between both feet. Perform five timesand make note of tightness, weakness orcoordination on one side versus the other. Theside that does not feel as natural or strong is theside you should focus on. Note that the back isslightly rounded, allowing for forward reach, asin skiing. For telemark skiers, keep the front footflat and go up onto the toes of the back foot withgood weight distribution. (See Fig. 2)

Stand with your arms out in front in poleposition. Jump forward a little and plant yourfeet at about 45 degree angles to the left, withyour right foot a little back of the left. Sink intoyour hips, shifting back on the downhill ski sideand notice what the movement feels like. Applythe same principles as above with foot width,weight distribution and trunk position. Performthe same on the opposite side, back and forth,and compare one side versus the other. Notethe square shoulders and even arm position. Fortelemark skiers, land with your front foot flatand your back foot on the toes with good, evenweight distribution. (See Fig.1)

Fig. 2

8 The OA Update

The plantar fascia is a strong fibrous band thatruns along the bottom of the foot connecting theheel bone to the toes. It provides arch supportand stability to the foot. Fasciitis is inflammationof the fascia. Pain is most commonly felt at thebottom of the heel extending into the arch.Plantar fasciitis is one of the most common footcomplaints and is a condition that affects peopleof all ages. The most common symptoms arepain and burning in the bottom of the heel. It istypically worse upon arising in the morning orafter being sedentary. Prolonged standing andwalking may exacerbate symptoms.

There are many factors that contribute toplantar fascia pain:

• Foot structure–flat foot, high arch• Tight Achilles tendon• New or increased physical activities• Weight• Shoe wear–poor support and/or cushion• Acute injury or fascia tear

The plantar fascia has a poor blood supplyand inflammation may take months to a yearto resolve. Early diagnosis and treatmentexpedites healing and pain relief. Plantarfasciitis is diagnosed by physical examinationand symptomatology. An x-ray can ruleout other causes of heel pain such as astress fracture. Bone spurs are often seen onx-ray and are not the cause of heel pain;many people have bone spurs and haveno pain.

Non-operative treatment is directed atdecreasing inflammation and pain:

• Appropriate shoes• Non-steroidal anti-inflammatory medications• Ice• Daily stretching and physical therapy• Orthotics–heel cushion, arch supports• Night splinting• Walking cast• Cortisone injection

Approximately 90 percent of patients will haveresolution of their symptoms with thetreatment algorithm. For persistent pain surgerymay be indicated. Extracorporeal shock wavetherapy is a noninvasive ultrasound performedunder light anesthesia to stimulate blood supplyand healing. Another surgical option is theplantar fascia release to loosen tight fibers at theattachment to the heel bone. Topaz™microtenotomy has proved to be a successfulminimally invasive surgical option. Underanesthesia small needle punctures are made toallow a radio frequency probe to release tightfascia and heat tissue to stimulate blood supplyand healing. There has been great success andpatient satisfaction with this procedure at theOA Foot and Ankle Center.

To learn more about your foot conditionand to determine what treatment options aremost appropriate for you, please see yourphysician for further guidance.

Plantar FasciitisBy Kristina Kramer, PA-COA Foot and Ankle Center

10 The OA Update

Anatomy of a FingerBending your fingers actually starts within yourforearm. The muscles responsible for themovement are located in the forearm—onemuscle for the thumb and two muscles for eachfinger. The muscle-tendon junctions, where themuscles blend into the tendons, are in the partof the forearm just before the wrist. The tendonsthen pass through the carpal tunnel and out intothe hand. At the base of the fingers and thumbthe tendons enter a sheath that guides them totheir insertion, or attachments. Without thesheath, the tendons would bowstring away fromthe bones and the fingers would not be able tomake a fist. A tissue called tenosynovium, whichprovides lubrication and nutrition, surroundsthe tendons. When the tendons become stuckor snap, the result is referred to as trigger finger.

CauseThe cause of trigger finger, in the vast majority ofcases, is idiopathic, or unknown, likely becausethere are many different factors that can result

in a trigger finger. Ultimately, the conditionresults from an imbalance between the normal“wear and tear” that we subject our bodies todaily, and the body’s ability to heal that damage.It is more commonly seen in patients withdiabetes, gout and rheumatoid arthritis.

SymptomsAs the tenosynovium becomes inflamed, itcauses pain at the base of the finger andpressure in the flexor tendon sheath. Thisresults in a crunching sensation withmovement of the finger and may result inswelling. As the tenosynovium becomesmore inflamed, the patient may experienceclicking and eventually, painful locking ofthe finger—either straight or bent, as anodule develops in the tendon and themouth of the tendon sheath thickens.

TreatmentInitial treatment for trigger finger involvesmoist heat in the morning and icing at

night with anti-inflammatory medications.Avoiding known provocative activities suchas weeding, knitting, and other thingsrequiring pinching, along with utilizingnight splinting, will help some patients. Ifthis fails, then occupational therapy may betried. Injections of cortisone are anotheroption. If these efforts fail, then surgerywhere the mouth of the tendon sheath isopened, taking the pressure off the tendon,may be necessary.

Additional resources: visit www.youtube.com.Search key words “ASSH Trigger Finger.”

Dr. Sacha Matthews is a hand surgeon in the OAHand Center, which provides comprehensive cov-erage for the diagnosis, treatment and rehabilita-tion of all types of hand and wrist problems. He isa fellow of the American Academy of OrthopaedicSurgeons and a member of the American Societyfor Surgery of the Hand. He also has a Certificateof Added Qualification in Hand Surgery.

By Sacha Matthews, MD

Trigger FingerWhat it is. Why it happens.

The OA Update 11

12 The OA Update

Linda Ruterbories MS, ANP-C and Dr. Douglas Brown in surgery

The OA Update 13

Leading the WayBy Carrie BuiOA Surgery Center celebrates 20 years

For the past 20 years OA Centers for Orthopaedics Surgery Center(OSC) has been providing a patient-focused healing environmentknown for its high-quality, cost-effective and cutting edge proceduresperformed by expert surgeons.

OSC’s parent organization, OA Centers for Orthopaedics (OA),was founded in 1982 with a vision and a commitment to provideoutstanding orthopaedics care in southern Maine—a concept that isthe foundation of OSC as well. The specialists at OA focus on aparticular area of the body such as the knee or hip, becoming expertsin diagnosing and treating related problems. The practice now includessatellite centers in Windham and Saco.

Multiple centers within OA’s Portland office provide convenienceand familiarity for the patient. “The patient has an MRI, a physicianfollow-up, a history and physical, pre-admission testing, surgery andphysical therapy all within the same building, allowing the patient andtheir family members not only a unique operative experience, but alsoa unique orthopaedic experience,” said Linda Ruterbories, ANP-C andDirector of the Surgery Center.

One of the founders of OA Centers for Orthopaedics, Dr. DouglasBrown, explained that an outpatient surgery center was always part ofthe plan. “As we contemplated building a new practice facility, we feltstrongly that we should aim to integrate our clinical practice with one,an outpatient surgery center, and two, an outpatient physical therapycenter. We felt confident that by owning and managing all three of theseorthopaedics practice facilities, we could ensure high quality, efficiencyand convenience—for patients and ourselves.”

“The OSC provides an environment that demands the high-quality care be delivered, focuses on patient safety and satisfaction atall times and promotes communication between staff and surgeonsresulting in innovative new ways to improve the care we provide,” saidThomas Murray, MD former Medical Director of the OSC.

14 The OA Update

It is also more cost effective due to several reasons, added Dr.Murray. Because of the specialized medical staff, surgical times tendto take less time than within a general setting. There are also lowercomplication rates, avoiding expensive problems, and hospitals alsocost-shift, to make up for the difference in insured and uninsuredpatients. Because the center performs a high volume of arthroscopicprocedures, they are able to negotiate a better rate for equipment andimplants. These savings are passed on to patients.

QualityThe surgery center is committed to performing quality outpatientsurgical procedures and is nationally recognized and accredited by theAccreditation Association for Ambulatory Health Care. “Everythingwe do, from reduced pre-operative waiting times to avoiding mixingpre-op and post-op patients demonstrate our desire to put ourselves inour patients’ shoes and treat them as we would like to be treatedourselves. Everybody is a VIP in the OSC,” said Dr. Murray.

Said Ruterbories, “Patient culture has shifted. They understandand identify with quality and make their own choices based on theseprinciples.” OSC strives to meet and exceed those expectations.

The OSC staff believes the key to a positive outpatient surgicalexperience begins by creating a caring environment for the patientsand their families. Patients who arrive at OA are immediately wrappedin a warm blanket—literally. “Patient’s family members are frequently

nervous and concerned throughout the time that their loved ones arein surgery, and when the warm blanket is placed on the patient in ourholding area, there is often a visible calm that comes over both thepatient and their family member,” Ruterbories explained.

OSC’s commitment to increase surgical knowledge, their ongoingdetermination to reassess and refine patient procedures and theirintrinsic dedication to patient comfort through the “warm blanket”philosophy, means OSC not only remains a leader in outpatientsurgical procedures, they enhance the quality of the patient experienceas well.

Quality begins before surgery, with a pre-admission visit (PAT)to the facility. Prior to a scheduled surgery, the patient meets with amedical assistant and tours the facility in order to feel more at easewithin the center’s environment. “This initial visit gives the patientand their support person an idea of what to expect on the day ofsurgery and gives them a chance to feel the nurturing environment,”Ruterbories said. “Most hospitals now perform the PAT over the phoneand the patient and the family never visits the facility until the dayof surgery.”

The surgery center was ranked No. 1 in the country for pre-procedure times by the AAAHC Institute for Quality improvementstudy of knee arthroscopy with menisectomy comparing 29 outpatientsurgical centers around the country representing 11,500 arthroscopiesannually, Ruterbories said. The pre-procedure time begins when the

*9003 represents OA’s Surgery CenterGraph included with the permission of the AAAHC Institute for Quality Improvement.

*

The OA Update 15

patient walks into the facility and ends when they enter the operatingroom. The average pre-procedure times of the other sites are 93minutes. The OSC average pre-procedure time is 63 minutes.

Ruterbories and the doctors continually attribute OSC’s success tothe staff. Said Dr. Brown, “Our people make the major difference—from those who clean the facility every day, to the instrumenttechnicians, who clean, maintain, sterilize and organize ourinstruments and equipment, to the specialized recovery room nurses,to the specialized OR nurses and scrub techs—everyone has becomemore capable every year. This also applies to the independentanesthesia group that we work with every day, all of whom have beenhandpicked for their expertise and interest in teamwork in ouroutpatient facility.”

Dr. Murray describes OSC’s “culture of accountability” as one ofits defining characteristics. He said, “Our OSC Director teaches eachstaff member that his or her performance is critical to each patient’squality care experience. Staff has a genuine interest in achievingexcellence in orthopaedics surgical care and does so daily.”

Quality care extends after the surgical procedure through follow-up calls to patients to check on them post-surgery. The employees goout of their way to try to reach the patients and that even extends intoholidays.“Linda came in on Friday (New Year’s Day) and called 17patients at home that day to see how they were doing,” said Dr.Murray. “I think she leads by example by doing that sort of thing, butshe expects that same kind of behavior from the other members.”

Periodic review of surgical outcomes is important for OA surgeonsto ensure a quality result for their patients. “We feel it is important toprove our surgeons have results comparable to the best reportedoutcomes.” said Donald P. Endrizzi MD, and Medical Director of theSurgery Center. “The staff excels at what they do and the physiciansare compelled to provide the best care for our patients. That meansreviewing our outcomes, participating in CME at a level higher thanthat required for board certification and continuing to introduce state-of-the-art orthopaedic surgical procedures to Maine and the greaterPortland area.”

SafetyThe surgery center carefully evaluates each potential patient todetermine whether or not outpatient surgery is a viable option. “Firstof all, the patient has to be a candidate for surgery that we knowwe can perform safely and comfortably as an outpatient,” explainedDr. Brown. “Second, the patient has to be in good enough generalhealth that they will not have any unusual risk factors, particularlyfor anesthesia.”

Due to the surgery center’s careful evaluation of eligible patientsand the specialized expertise, the surgery center has lower complicationrates than a hospital, however, preparing for the worst keepscomplications in check. All OSC nurses are ACLS certified, MalignantHyperthermia drills are performed annually, and in-services areprovided to all employees covering topics ranging from avoidablecomplications to response to medical emergencies.

The physicians of OA Centers for Orthopaedics are committed to providing

quality care that results in the best patient outcomes. Our physicians are

orthopaedic sub-specialists trained in one or two specific fields of interest.

Consequently, the surgeons perform a high volume of the same types of

specialized surgery both in the Orthopaedic Surgery Center (OSC) as well

as at the local hospitals. We believe, and research has shown, that more

experience leads to better outcomes for patients.

Most common procedures performed in OSC in 2009

Knee Surgeries 1,145

Shoulder Surgeries 919

Hand/Wrist Surgeries 409

Foot/Ankle Surgeries 315

Spine Surgery 46

Hip Surgeries 44

Total joint replacement procedures performed in a hospital setting in 2009

Total Hip Replacement 797

Total Knee Replacement 686

Total Shoulder Replacement 95

Practice Makes Perfect!

Dr. Thomas Murray and Scott Benevides, PA-C in surgery

16 The OA Update

InnovationAcross the last 20 years, the staff at OA’s Surgery Center has benefited fromnumerous technological advances. Ruterbories cited the advances in anestheticsand in digital imaging as being especially beneficial. As medicine and technologycontinue to intersect, OA intends to be at the forefront of medical advancementand for their patients to reap the rewards of increased efficiency, lowered costsand faster healing. Ruterbories said electronic health records will add to thepractice’s ability to be efficient, and minimally invasive procedures will allowmore surgeries to be performed in an outpatient setting at a lower cost.

One of the center’s initial innovations dealt with minimizing painmanagement for patients. The center tracked pain management and post-operative nausea and vomiting. Said Ruterbories, “We did the research andfollowed patients very closely to make sure that they were getting the bestpossible all-around experience, from minimizing pain to being satisfied withtheir surgical experience.”

Every subspecialty area of orthopaedics has been impacted by improvedpain management. “We have been able to perform many procedures fromfractures and joint reconstructions, through spine surgery and total jointarthroplasties that 20 years ago would not have been possible on an outpatientbasis,” added Dr. Endrizzi.

Hand and foot and ankle surgery have been significant areas of growthwithin OA Centers for Orthopaedics. Dirk Asherman, MD a foot and anklesurgeon, joined the practice in 2000. Advances in foot and ankle surgery haveallowed more complex operations such as subtalar, ankle and midfoot fusionsand ankle ligament reconstructions to be performed in an outpatient setting. Theaddition of popliteal blocks performed by the anesthesia service provides furtherpain control allowing for even more complex procedures to be performed inthe center. Other foot and ankle procedures routinely done within OSC areAchilles tendon repairs, and internal fixation of ankle fractures.

When Sacha Matthews, MD joined OA in 2003, his expertise in handOSC Staff Training

OA Waiting Room

The OA Update 17

brought complex hand and wrist procedures to the surgery center that previouslywould not have been done in an outpatient setting. Advances in equipment inhand surgery include a special table that allows patients to stay on the stretcherinstead of having to transfer them to a more uncomfortable operating table.This table has streamlined the patient flow. The latest developments in handsurgery in OSC include the use of nerve grafts and neural tubes for the treatmentof nerve injuries.

The addition of these two surgeons warranted an expansion that includedbuilding two additional operating rooms and expanding the adjoining patientsupport areas.

OSC has always positioned itself as a leader in outpatient surgicalprocedures and that tradition continues today. The surgery center was apioneer in outpatient knee ligament reconstruction, outpatient meniscustransplantation, allograft articular cartilage transplantation and newshoulder arthroscopy procedures. “The OSC continues to be the leader innorthern New England for arthroscopic knee, shoulder, wrist, elbow, ankleand hip arthroscopy,” said Dr. Murray.

Added Dr. Brown, “Most recently, one of our surgeons has perfected thetechniques and the environment to safely and comfortably perform total hipreplacements as an outpatient procedure, something that is highly innovative anddone only in a handful of places in the world.”

“Much of orthopaedics research today is focusing on growth factors thatwill allow us to speed the healing of bone and soft tissue injuries and replacecartilage defects. Joint replacement technique improvements will likely result inoutpatient knee and hip replacements becoming more common,” said Dr.Murray. The center is currently tracking common benchmarks for shoulderprocedures post-surgery to see when the benchmarks are achieved. Tracking theprogress of patients helps the surgery center measure quality.

The surgery center’s attention to quality, safety and innovation ensures itscontinued success.

Brian Halla, PA-C scrubbing for surgeryAnesthesiologist monitoring a patient during surgery

18 The OA Update

The OA Update 19

By Stacey Doyon, OTR/L, CHT

Holding HandsThe specialty of hand therapy

20 The OA Update

OA offers hand therapy services at both itsPortland and Saco offices. A hand therapist iseither an occupational therapist or a physicaltherapist who, through extra training andexperience, develops specialized knowledge ofthe upper extremity (arm). Hand therapistshave a more in-depth knowledge of anatomy,surgical procedures and wound healing.Therefore, we are able to get you better faster,as well as help patients understand whentherapy is not a benefit. Both OA facilities usehand therapists that have advancedcertification as certified hand therapists. Inorder to sit for the CHT exam, a therapistmust have at least five years of experience, andmore than 4,000 hours providing therapyspecifically in the area of hand therapy. CHTsmust maintain certification through annualcontinuing education courses to ensurequality care for patients.

Why hand specialists?The hand is very complicated. It is comprisedof 27 bones held together by a series ofligaments. Ligaments go from bone to boneand allow movement. Helping to move yourfingers are tendons (going from muscle tobone) and muscle. Some of the smaller

muscles are in the palm of the hand. Thelarger muscles are actually in the forearm andstart at the elbow. There are no muscles in thefingers themselves. The muscles are able tofunction by nerves. The three main nervesthat affect the hand are the median, radial andulna. These nerves innervate the muscles thathelp move the fingers and provide sensationto the hand. One of the complicating factorsof the hand is that problems occurring in theneck and shoulder region can actually showup in the hand. A hand therapist must be ableto screen this region as well.

What does a hand therapist do?Patients of all ages, from infancy toadulthood, are treated by hand therapists.We evaluate and treat any problem thatoccurs with the finger, hand, wrist, forearmor elbow. Patients can be seen after a surgeryor after an injury. Patients may alsoexperience a condition from overusing theirhands/arms or from ongoing problems dueto an illness or disease. CHTs may also seepatients to prevent further injury.

These injuries and diseases may includefractures, sprains, arthritis (osteoarthritisand rheumatoid arthritis), overuse issues

(e.g., tennis elbow), burns, congenitaldeformities, tendon lacerations, crushinjuries and nerve injuries. OA’s course ofaction always starts with a full evaluation todetermine what treatment would best suitthe patient. Treatment is then variable andmay include any of the following:• Regaining range of motion• Strengthening• Coordination• Controlling swelling• Treating pain• Managing a healing wound to be certain

it does not become infected• Managing scar formation so it will not

stick to underlying tissue• Sensory reeducation• Education with regard to ergonomics and

job modifications.

Hand specialists also do splinting (orthotics).Splints are used for a variety of reasons. Theycan support a joint, protect a joint so it healsproperly or increase range of motion. Splintsare either custom-made or prefabricated.The hand therapist is trained to understandwhich splint is the best one for an injury ordisease, as well as how to fit them properly.

Why use a hand therapist?Because of our advanced training andspecialized knowledge hand therapists areable to provide more effective and efficienttreatment. Because our practice is focused onone area of the body we are able to identifywhat is, or is not, typical for an injury ordisease. If an injury is not typical then weknow to contact the physician about thesituation and explain our concerns in greaterdetail. The unique thing about gettingtreated at OA is that the physiciansare immediately available for consultationregarding findings that are not consistentwith an injury or disease.

If you would like more information inregards to hand therapy, please feel free to ask yourOA doctor or contact one of the hand therapists.

Stacey L. Doyon, OTR/L, CHT- Portland Of-fice 207-828-2121 or Catherine Morell-Ambo,OTR, CHT-Saco Office 207-710-5504

CHTs treat a variety of hand, wrist, forearm and

elbow injuries including but not limited to:

• Osteoarthritis—this occurs a lot on the base

of the thumb

• Rheumatoid arthritis

• Sprains and ligament tears

• Fractures of a finger, wrist, forearm or elbow

• Overuse syndromes such as tennis elbow,

golfer’s elbow, deQuervain’s syndrome

(pain on thumb side of wrist)

• Carpal tunnel syndrome

• Tendon lacerations

• Amputations

What types of injuries or conditions does a hand therapist see?

The OA Update 21

OA Centers for Orthopaedics thanks the following advertisers for making this publication possible.

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Berry, Dunn, McNeil & Parker ........................................ 21

Broom Service Inc. .........................................................17

Creative Printed Solutions Inc71 Pleasant Hill Rd.PO Box 6660Scarborough, ME 04074 (207) 939-8523 • Fax (207) 883-1580

www.thecreativecompanies.com

DJO Incorporated........................................................... 21

Ethos Marketing & Design............................................. 23

Ferring Pharmaceuticals................................................. 9

Hebert Construction LLC ............................................... 11

Maine Medical Center ................................................... 22

Maine Uniform .............................................................. 18

Mercy Hospital ................................................................ 2

New England Medical Transcription Inc ........................ 18

New England Rehabilitation Hospital of Portland ......... 21

PDT Architects............................................................... 18

RBC Wealth Management ............................................. 11

Spectrum Medical Group............................................... 11

Surgical Systems Inc..................................................... 24

22 The OA Update

Advertising Directory

The OA Update 23

OA Centers for Orthopaedics33 Sewall St.Portland, Maine 04102