September 8, 2012 - 7:00 - 8:00 AM
Instructional courses are scheduled concurrently; please see below for detailed descriptions and locations.
CME Available: The ASSH designates this live activity, for a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
IC29: How to Get Involved and how to Advance in ASSH
Moderator: Steven Z. Glickel, MD
Location: Plaza B, Hyatt Regency Convention Center
This course is designed to provide a template for all members, private and academic, to become involved in the committee structure and governance of the ASSH. Toward that end, the faculty will review the governance structure including the divisions and committees within them. We will clarify the mechanisms within Council by which committee appointments are made and committee chair and member performance assessed. We will present the Young Leaders Program and alternate routes for involvement in the ASSH like the Journal of Hand Surgery and the American Foundation for Surgery of the Hand. The faculty will also discuss the Nominating process by which members are elected to positions on Council. The goal of this Instructional Course is to make it as clear as possible that the ASSH wants and encourages participation by members from diverse backgrounds including practice type, both private and academic.
- Navigate through the governance structure of the ASSH and know where they might best fit.
- Analyze the committee structure of the ASSH to know where their skills and interests could be used most constructively.
- Define the paths to leadership in the ASSH based upon the experience of some members who have navigated those paths.
- Analyze the ways in which all members (private and academic) can suceed in the committee and governance structure of the ASSH.
- Interact with leaders of the ASSH in an open forum.
James Chang, MD
Scott H. Kozin, MD
Fraser J. Leversedge, MD
Mark C. Anderson, FASAE, CAE
IC30: How to Get a Manuscript Published
Moderator: Roy A. Meals, MD
Location: Acapulco, Hyatt Regency Convention Center
Pitfalls lurk at every step when transforming an idea into a publishable scientific paper. Dr. Meals brings his decades of experience as an author (both successful and unsuccessful), reviewer and journal editor to bear on the creative process and shows the participant how to take a study efficiently from conception to publication. Dr. Meals enriches and enlivens the presentation with quotes from authors and editors through the ages who have experienced the agonies and thrills of converting ideas and observations into permanent records of intellectual pursuit. The presented material is equally applicable to clinical and basic science endeavors. Time will allow for participants to share questions, frustrations, tips and insights. Although listed as intermediate in content, neophytes and masters will also find practical material to facilitate their investigative reporting. Even those who do not anticipate preparing a manuscript for publication will find the course stimulating because it elucidates the unseen efforts of the many people involved in producing a meaningful publication.
- Recognize ideas that may lead to publishable manuscripts.
- Design the study, identify authorship, and do the work in a logical, efficient, ethical sequence.
- Write the paper in an orderly manner and polish its content and form.
- Deal with recommended revisions, rejoice in acceptance or rebound from rejection.
IC31: A Primer of Estate, Business and Wealth Preservation Planning for Surgeons
Moderator: Frank C. Hui, MD, JD, LLM (Tax)
Location: Regency D, Hyatt Regency Convention Center
The course is designed to give a synopsis to busy surgeons who have a desire to consider, but have not pursued Business or Wealth Preservation planning because of their busy schedule. I want to help surgeons to overcome the inherent distrust of attorneys and fear of the legal process. It will be presented in a Power Point format and in a manner that can easily be understood by an audience without extensive legal training. Principals will be explained with real life and hypothetical scenarios commonly encountered by surgeons. The ultimate goal of the course is to allow the audience to understand Wealth Preservation issues unique to surgeons and give them enough basic knowledge to actively participate in the planning process with their attorneys if and when they desire to do so.
- Understand the unique position of Surgeons that require special Wealth Preservation and Wealth Transfer Planning strategies.
- Distinguish legitimate Asset Protection techniques from fraudulent transfers, tax evasions and asset concealments.
- Understand the legal basis of using Trusts, Entities and Valuation Discounts for Estate, Business and Wealth Preservation Planning including the potential legal challenges.
- Recognize the indications of using some of the widely used Wealth Preservation strategies without learning all the legal details.
IC32: Elbow Arthroscopy: Indications, Techniques, Outcomes and Complications
Moderator: Julie E. Adams, MD
Location: Regency C, Hyatt Regency Convention Center
Arthroscopy is increasingly accepted for treatment of certain conditions about the elbow. Published studies have investigated use of arthroscopic treatment for traumatic and degenerative conditions. This course will outline techniques for performing arthroscopic procedures at the elbow with a specific focus on indications, tips and pearls and outcomes.
Treatment alternatives to arthroscopy will be discussed.
Potential complications will be studied with emphasis on how to avoid them. Interactive case discussions will highlight principles of treatment and pearls and pitfalls.
- Recognize indications and contraindications for elbow arthroscopy.
- Outline techniques for performing arthroscopic procedures at the elbow.
- Be aware of strategies to treat rheumatoid arthritis, osteoarthritis, tendonopathy about the elbow and other conditions.
- Be aware of potential complications and strategies to avoid them.
IC33: Targeted Muscle Reinnervation
Moderator: Brian T. Carlsen, MD
Location: Comiskey, Hyatt Regency Convention Center
This instructional course will introduce the background, indications, technique and future of targeted muscle reinnervation. There are estimated more than 41,000 people in the U.S. living with major upper extremity limb loss. Depending on the level of amputation, functional improvement for upper extremity amputees includes autologous reconstruction, prosthetics and hand allotransplantation. When the level of amputation is proximal to the elbow, prosthetic use is the most viable and option for functional upper extremity restoration. Targeted muscle reinnervation (TMR) refers to surgically transferring transected nerves that control elbow, forearm, wrist and hand function to available muscles so that the contracture of these muscles can be used to signal intuitive prosthetic function. The procedure has been successful at providing intuitive prosthetic control in patients with proximal upper extremity amputations. The problem with myoelectric control for the proximal amputee is that there are limited muscles available for intuitive prosthetic control. For amputation at the transhumeral level, the biceps and triceps provide the only remaining signals for myoelectric control. It is important to maintain native signals to these muscles for intuitive elbow control for the prosthesis. Unfortunately, hand and wrist control with the biceps and triceps is difficult and requires cognitive oversight. For patients with shoulder disarticulation, there are more motor units available but a greater need for myoelectric signals. Targeted muscle reinnervation for the transhumeral amputee involves denervation and median nerve transfer to the short head of the biceps and denervation and distal radial nerve transfer to the lateral head of the tricep muscle. With these new myoelectric signals, wrist and hand function control of the prosthetic is much more intuitive. For the shoulder disarticulation patient, the shoulder girdle muscles are utilized for nerve transfer for intuitive elbow, wrist and hand control. Despite the promise that TMR has shown, current challenges remain. The signals provided by the entire median nerve are not directed at a single function or task such as ‘hand close.’ Prosthetic fitting can be a challenge due to the location, strength and mobility of the signals. Research in this exciting area of upper extremity prosthetics control is responding to these challenges. Pattern recognition refers to a topographic map of myoelectric signals that can be used to control specific and more complicated tasks. Recent advancements in this field means the future is very encouraging for all of those living with upper extremity limb loss.
- Understand the concept of targeted muscle reinnervation (TMR).
- Identify appropriate candidates for TMR.
- Understand the surgical technique of TMR for amputees at the transhumeral and shoulder disarticulation level.
- Understand the remaining challenges in prosthetic use for upper extremity amputees.
- Understand the promise of research to improve the lives of patients with limb loss.
Todd Kuiken, MD, PhD
Gregory A. Dumanian, MD
Laura Miller, CP, PhD
Levi Hargrove, PhD
IC34: TFCC Repair: Open vs. Closed? Old Reliable and New
Moderator: Jeffrey Yao, MD
Location: Columbus I-L, Hyatt Regency Convention Center
Injuries to the triangular fibrocartilage complex (TFCC) are a common cause of ulnar-sided wrist pain. Treatment of these injuries has evolved significantly over the past few decades. The goal of this ICL is to provide a historical review of previous and current methods of TFCC repairs, as well as to explore newer techniques and current controversies surrounding this common injury. Finally, we will explore existing salvage procedures for failed previous treatment of TFCC injuries.
- Use patient history, physical findings and imaging studies to diagnose injuries to the triangular fibrocartilage complex.
- Understand the evolution of the treatment of this common cause of ulnar sided wrist pain.
- Determine when soft tissue/capsular or bony/foveal repairs of the TFCC should be employed.
- Understand new techniques for repair.
- Understand salvage procedures for previously failed TFCC treatment.
IC35: Computer Use in Hand Surgery: Voice Recognition, Electronic Records, Custom Programming and More
Moderator: Stephen J. Leibovic, MD
Location: Columbus CD, Hyatt Regency Convention Center
Computers are essential in today’s practice environment. We depend on them for documenting and storing clinical data. We need to be maximally efficient in data entry and retrieval. Voice recognition is very useful if properly implemented. We will discuss useful features of Dragon voice recognition software including macros and custom programming. Methods to speed up and improve accuracy in voice transcription will be covered, including macros and autotext features with and without integration with MSWord. Training tips to improve accuracy will be reviewed. We will show how other physicians have adapted to the data entry requirements of a select few EMR systems.
We will select a few EMR systems and highlight different methods of data entry in these systems. While all EMR systems allow voice, keyboard and mouse entry, features differ between different systems. We will also show how to create custom applications for data entry and case recording, useful for research and documentation. Custom programming, as well as off the shelf applications (i.e. MSAccess) will be discussed. After attending this course, the attendee will be equipped to make their own practice more efficient with a variety of computer based methods.
We will also review basic concepts, tips and tricks for organizing large numbers of image and video files. Strategies for archiving, indexing and searching will be reviewed. Emphasis will be on concepts for implementation which can be applied to different programs and different operating systems. The goal is to create a scalable system for managing digital media without being tethered to a proprietary file system or programming language.
- Write macros and apply custom programming within Dragon.
- Understand limitations and benefits of data entry methods in a few select EMRs.
- Recognize when custom programming is useful in data collection and analysis.
IC36: Revision Peripheral Nerve Surgery? When and How
Moderator: Glenn R. Gaston, MD
Location: Columbus EF, Hyatt Regency Convention Center
All hand surgeons are well versed in the management of peripheral nerve compression and peripheral nerve injuries. Carpal tunnel release, cubital tunnel release and peripheral nerve repairs are among the most common procedures performed by hand surgeons. Overall high success rates are reported for the management of these common conditions; however, failures still occur and revisions are necessary at times. Surprisingly, there is a paucity of literature and guidance for the management of failed primary peripheral nerve surgery.
This course will first review peripheral nerve physiology in response to injury. Understanding a nerves response to chronic compression or repair is critical in determining timing of revision surgery and choosing the most appropriate revision surgery. Next, case presentations to highlight treatment options, timing of revision and outcomes of revision carpal tunnel, revision cubital tunnel and revision peripheral nerve repairs will be presented by the panel. The distinction between persistent and recurrent peripheral nerve compression will be highlighted and an algorithmic approach to revision surgery offered. Differential diagnoses as well as etiologies of failed surgeries will be reviewed for each case as well. Intraoperative strategies and pearls will be discussed.
Lastly, the group will discuss nerve coverage for the chronically scarred nerve. This will include the role of vein wrapping versus newer orthobiologic “nerve wraps” as compared to local, regional or free flap coverage in revision nerve surgery.
- Understand the management of recurrent carpal tunnel syndrome.
- Understand the management of recurrent cubital tunnel syndrome.
- Understand the management of failed peripheral nerve repairs.
- Understand the role of vein wrapping and orthobiologics in revision peripheral nerve surgery.
- Understand the physiology of peripheral nerve repair.
IC37: Current Concepts in the Management of Wrist Arthritis
Moderator: Sumedh C. Talwalkar, FRCS(Orth)
Location: Columbus AB, Hyatt Regency Convention Center
The wrist joint functions with the help of a complex interaction of multiple articulations. Arthritis of the wrist joint, which may result from primary and post-traumatic arthrosis or inflammatory arthritis, can result in significant disability. Surgical management is indicated in patients with pain that does not respond to activity modification, analgesia, splintage and disease modifying drugs. The aim of surgical management is to relieve pain with optimal preservation of function. The options for surgical treatment can be motion preserving (total wrist replacement, proximal row carpectomy, intercarpal fusions) or motion eliminating (arthrodesis). Wrist arthrodesis is a well-established procedure that predictably relieves pain and provides a stable wrist for power grip. It results in a high degree of patient satisfaction with respect to pain relief and correction of deformity. Total wrist arthroplasty is preferred for preservation of joint motion but has a less predictable outcome in non-inflammatory arthritis and tends to be preferred for older less active patients. The current perspectives in total wrist arthroplasty will be explored with reference to the local experience and current surgical literature. The outcome in wrist arthroplasty is influenced by diagnosis, pre-operative range of movement and surgical approach. Modes of failure include persistent pain, joint stiffness, synovitis, instability, loss of strength and implant failure (usually the distal fixation). Salvage procedures following a failed joint arthroplasty will be discussed.
- Describe the surgical anatomy, biomechanics and surgical approaches for the wrist joint.
- Understand the indications, technique and complications of conservative management and role of limited wrist fusion in the management of wrist arthritis.
- Understand the indications, technique and complications of wrist arthrodesis.
- Understand the indications, technique and complications total wrist arthroplasty.
- Discuss techniques for revision and salvage of a failed total wrist arthroplasty.
Ian A. Trail, MD
Adam C. Watts, MBBS
Michael J. Hayton, MBChB
Brian D. Adams, MD
View faculty disclosures here.
IC38: Utilizing the iPhone and iPad in a Hand Surgery Practice
Moderator: Scott Duncan, MD, MPH
Location: Regency B, Hyatt Regency Convention Center
The spread of smartphones and tablet devices has changed how physicians can access data. Healthcare has been accused of being slow to implement IT solutions to patient care facilities. However, physicians have been utilizing these new devices in ever increasing rates. Because of this, physicians are now demanding that IT services support these devices to help them access the data that is critical for patient care. The iPhone and the iPad have proven to be particularly popular with doctors. One of the key factors to the success of these devices has been the large number of Apps, specifically healthcare related Apps. This course is meant to educate the hand surgeon on a few of the common Apps and implementation strategies for these devices in a Hand Surgery practice.
- Define different methods to access relevant practice data.
- List Apps that are useful caring for patients and managing your practice.
- Apply Apps is a manner that is effective.
Rick F. Papandrea, MD
View faculty disclosures here.