MDNews - San Antonio

integration produces has led Mark Thornton, M.D., a doctor of internal medicine who practices in North Central San Antonio, to consistently send patients to the Hand Institute for conditions such as arthritis, carpal tunnel syndrome, trigger finger and fractures. "I've been referring patients to the Hand Institute at The San Antonio Orthopaedic Group for many years because of the experienced, reputable physicians there," says Dr. Thornton. "My patients also like the convenience of going there because the Hand Institute has its own surgery center and can do everything in one building." A One-Stop Approach The "one-stop" approach to patient care begins with diagnostics, including equipment for imaging small parts of the body such as the hand and wrist. Digital X-ray imaging, MRI scans and CT scans are available on-site, with facilities dedicated solely to ortho- paedic imaging. All diagnostic images are reviewed by both the surgeon and radiologists trained in the musculoskeletal specialty. "We've invested in these ancillaries in order to diagnose and treat at the same visit," says Paul Pace, M.D., of the Hand Institute. "We aren't going to make our patients hop in the car and drive down the road to get an image and have to wait for the results to come in before we can treat them." The Hand Institute physicians are supported by professionals with expertise in several areas of patient care. For example, highly trained certified hand therapists (CHTs) play an important role. Combining elements of occupational therapy and physical therapy, hand therapists work with patients to prevent dysfunction, restore function and reverse the progression of pathology to give patients maximum use of their arms, wrists and hands. The CHTs help patients avoid surgery when possible. When a surgical procedure is necessary, the involvement of a CHT helps improve surgical outcomes. The in-house team of experts who work with the Hand Institute also features electromyography (EMG) physicians, including a board-certified neurologist and a physical medicine and rehabilita- tion (PM&R) physician. Through EMG and nerve-conduction studies, these specialists are able to identify the source of muscle weakness, numbness, spasms, paralysis or pain. These diagnostic tools pinpoint the source of dysfunction, whether it's pinched nerves, inflamed muscles, carpal tunnel syndrome or nerve disorders, so physicians can properly treat symptoms. PM&R physicians also provide pain-management strategies as an alternative to surgery. In fact, the Hand Institute physicians, even though they're all board-certified and fellowship-trained, pride themselves on taking a conservative, non-surgical approach to treatment whenever possible. Dr. Pace estimates that only 60% to 70% of cases at the Hand Institute end in surgery after other, non-invasive treatment options have been tried, including preventive exercises, therapy, and vitamin B6 or other injections. "Prevention is something we emphasize, and not all hand surgeons do," says Alexander Rowland, M.D., of the Hand Institute. "Sometimes surgery is the solution, but we definitely have a conservative, non-operative approach to treatment. At Stephen Drukker, M.D. MDNEWS.COM ■ MD NEWS San Antonio | 7 some hand care centers, there's a 90% chance of surgery when you walk in the door." For example, carpal tunnel syndrome, if caught early enough, often responds to preventive exercise and other techniques to decrease inflammation in wrist tendons, reversing the dysfunction so that surgery can be avoided. If surgery does prove necessary, The San Antonio Orthopaedic Group's Outpatient Orthopaedic Surgery Center is designed with state-of-the-art equipment that supports the group's dedication to minimally invasive surgery techniques, including endoscopic carpal tunnel release. The surgery center features high-definition arthroscopy that provides vivid, wide-angle views of joints to help surgeons operate without impacting critical structures, resulting in a quicker recovery, minimal scarring and improved functionality within the joint. The Hand Institute physicians stay at the forefront of patient care advances. All of the Hand Institute physicians undergo continuing education to study new advances in hand care and are often among the first to bring new treatment modalities to San Antonio. For example, Dr. Drukker was one of the first physicians to offer percutaneous fasciotomy in San Antonio. A treatment for Dupuytren's disease, a thickening of the fascia that can lead to contracture of the palm and fingers, this minimally invasive procedure is significantly less expensive than — and as effective as — collagenase injections. PHOTOS © GARY PERKINS PHOTOGRAPHY

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