Rochester Regional Health orthopedic surgeon, who specializes in the hand, wrist and upper extremities, talks about new techniques for complex surgeries, latest development in the field, carpal tunnel and why she chose this field of medicine
By Chris Motola
Q: What are the most common hand injuries you see in your patients?
A: Oh, there are so many, because you use the hand for just about everything. Unfortunately, that leaves it vulnerable to injury — fractures, dislocations, lacerations, tendons, nerves, arteries. I wouldn’t say there is just one kind of injury and every injury is different in how it presents and what kind of pattern it has, which I think is awesome because it keeps my job extremely interesting. But that said, there are definitely common patterns, whether it’s from slips and falls or industrial work or workplace injuries.
Q: How complex do your surgeries get?
A: There is a lot of variety there too. You can have a relatively straightforward fracture or you can have an incredibly complex fracture where the pieces are so small we don’t even have screws that are the right size to fixate that. And then we have to use other strategies to bridge it or go around it, obtain fixation in other ways. So, something like a wrist fracture can have incredible complexity and a variety of ways to treat it. So that definitely keeps it interesting. I need to be considering all the possibilities when I am looking at an X-ray or talking to a patient or making a plan for how we’re going to treat that.
Q: What do you do when you’re dealing with really small bone fragments?
A: So a new technique that we have is something called the dorsal spanning plate for distal radius fractures. It’s actually something like an external fixator, which you may have seen in the movies. It’s where they have these rods that stick out through the skin and attach to the bone underneath the skin and hold everything in line. And as you can imagine, no patient enjoys having that on them. So, what this plate does is it slides underneath the skin and fixes to the metacarpal in the hand and then the radius more proximally. And then pulls everything out to length indirectly. And the awesome thing about that is that we don’t have to open the fracture and try to fix these tiny little pieces because we’re fixing them indirectly. And then once the fracture is healed a few months later, I can go in and remove that plate and get them moving again, So that’s been a real game changer for those really difficult fractures of the wrist that have tiny little pieces that we just can’t directly fix.
Q: How are the outcomes, typically, for more complex hand surgeries?
A: It’s been all over the place. I’ve been truly amazed. And so, you know, I’ve had people who are musicians who were asking me, “Hey, am I going to be able to play my instrument after all this?” And, of course, you never want to promise something you can’t guarantee. But I’ve been really impressed by how people get back to things afterwards.
Q: Given the dimensions, are hand surgeries usually open surgeries? Are there minimally invasive hand surgeries?
A: I would say most of the work I do is open, but some of the incisions are only like a centimeter big. I do a pretty broad spectrum of surgeries with very small incisions to large incisions. Something like an endoscopic carpal tunnel releases, the incision is less than a centimeter and most of the surgery is done under the guidance of a camera.
Q: It might just be my perception, but I don’t feel like I hear about carpal tunnel as much as I did many years ago. Has anything changed with regard to diagnosis and treatment?
A: It’s still there. It’s a huge problem. It’s painful and keeps people from sleeping at night and from doing things that they want to do. We’ve kind of come up with different treatments and then kind of gone back to older treatments. So, there are two ways to treat it. One is an open incision in the palm, and the other is the endoscopic way I talked about with like the smaller incision and camera guidance. And they’re both great options and have relatively similar results in the literature. But there are some factors that might steer someone more towards one way or the other. That’s something I would always discuss with a patient so that they can make an educated decision.
Q: Do we have a better sense of the causes now?
A: That’s a great question. So, we used to think it was things like repetitive activities like typing, but we have not been able to prove that. For whatever reason, if you get swelling in this certain spot and your wrist, it just puts too much pressure on the nerve and it starts choking off the blood supply to the nerve. So, what we’re trying to do is relieve pressure to the nerve so that the blood supply can return and so that the nerve can heal. There are conservative treatments you can do like wearing a brace or getting steroid injections. And then if those don’t work, then that’s when we start talking about surgery.
Q: What originally got you interested in hand surgery?
A: Well, I broke my hand, which I am sure is like the common reason people get into orthopedics. Every step along the way, I’ve just found hand surgery to be incredibly fascinating and also really fulfilling because we all need to use our hands every day to live and work and play. So being able to help people get back to doing the things that they want to do is incredibly fulfilling.
Q: Are there any good tips for keeping your hands strong and healthy?
A: Just keep going, keep moving, keep using them, keep active. That’s the most important thing for staying healthy everywhere in your body. It applies to your hands as well.
Q: Are there any new interesting treatments or procedures that are coming down the pipeline that you’re excited about?
A: I think there’s a lot going on with basic science research and how we heal. The biggest problem with how we heal is that we make scar tissue when we heal. It can make you stiff and can make it harder for you to get back the motion and the flexibility that you want to have after an injury. And so there is a lot of basic science research right now going on and how can we stimulate the healing response while minimizing the scarring response, so that we don’t have as many issues with stiffness. And as far as I know, we’re not quite there, but we’re making a lot of goals. And I am hoping that people who are way smarter than me will figure that all out, because that would be amazing. But one thing we’re doing just in practice is trying to get people moving as soon as we can and trying to mitigate the stiffness and those kinds of issues after an injury or after surgery.
Q: What brought you to the Rochester area? And you’re not originally from the Rochester area, are you?
A: I have family ties here. My brother was born in Rochester. My father went to nursing school at the University of Rochester. So we always would come back here in the summer. I have a lot of good family memories here. Although now I understand we always came back in the summer and not in the winter.
Lifelines
Name: Emily Morgan, M.D.
Position: Orthopedic hand surgeon at Finger Lakes Bone & Joint; Rochester Regional Health orthopedic offices in Geneva, Victor and Linden Oaks
Hometown: Fayette, Missouri
Education: Doctor of Medicine degree from the University of Chicago-Pritzker; completed an orthopedic surgery residency at Madigan Army Medical Center; and completed a hand surgery fellowship at Walter Reed National Military Medical Center.
Specialty: Board-certified orthopedic surgeon specializing in the full spectrum of hand and upper-extremity conditions, including nerve compression syndromes, traumatic injuries, arthritis, sports injuries, tendonitis, and upper-extremity masses.
Affiliations: Rochester Regional Health system
Organizations: American Association of Orthopedic Surgeons; American Society for Surgery of the Hand
Family: Husband, two children
Hobbies: Working out, outdoor activities, cooking, crocheting, knitting.