Common Questions

COVID-19 NOTICE:

March 27, 2020

Dear Patients, Referring Physicians and Colleagues,

In response to COVID-19, we want to reassure everyone that our Center is currently open. Unless otherwise mandated, our Center will remain open Monday through Friday, and we will also continue to be available for telephone consultation at any time, including after our Center has closed for the day.

Specifically, our goal is to help those in our community, with hand and wrist injuries, bypass our local, overwhelmed urgent care centers, emergency rooms, and hospitals.

We continue to be available for pressing and urgent appointments and we can now also provide most surgical services on site. 

We are also now offering (video-chat) Telehealth Services via Zoom for both new and established patients. The scope of this new service is to provide preliminary evaluation, screening and treatment recommendations for sick patients and/or any patient who is unable to physically visit our Center at this time. Additional details regarding our Telehealth Services will be posted on our website soon.

We continue to take evolving measures to ensure the health and cleanliness of our Center on a daily basis. Please be assured that we are taking the necessary precautions to ensure everyone’s safety, and therefore, we are enforcing the following, additional steps for all appointments and visits:

 

  • Hand sanitizers are available throughout our Center, but hand washing before and after all appointments is mandatory. Our staff can assist patients with handwashing whenever necessary.

 

  • We are enforcing “check-in by telephone” for all in-office appointments. Patients can simply call us when they arrive at our Center (and are parked outside) and wait in their vehicle until an exam room is ready for them.

 

  • Copays, coinsurance and all other payments can be processed by telephone.

 

  • We have an online Patient Portal handwristportal.com where copies of medical records, copies of completed patient forms, school and work notes can be viewed and downloaded at any time after all appointments.

 

  • Our Center can now process disability forms electronically with the Employment Development Department (EDD). And paper claim forms can still be processed at any time.

 

We will continue to update our website with evolving information regarding our services, hours and other Center information as changes arise.

In the meantime, we hope that this information is reassuring and helpful, and we sincerely thank you for your continued business!

Wishing everyone health,  

Ross Nathan, M.D., Medical Director                         Amanda Merino, Administrator

 

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Q: What is Needle Aponeurotomy?

A: Needle Aponeurotomy is a minimally invasive procedure by which tight palmar cords (contractures) are released through the process of percutaneously penetrating the soft-tissue layer (fascia) located directly under the palmar skin surface. Simultaneous, when indicated, Cortisone injections are administered during this process, which help discourage reformation of the cells that cause these palmar cords. Once the cord has been penetrated (cut) by the needle, the “break” allows for the contracture to potentially release, thus allowing digital and palmar extension to occur immediately. The primary focus of this procedure is to provide as many releases as possible while minimizing the possibility to reform scar tissue which causes these cords. N.A. is not a cure for Dupuytren’s Disease (Contractures), but it is a less-invasive method by which this condition can be addressed without traditional, open surgery.

Q: Am I a candidate for Needle Aponeurotomy?

A: To definitively determine if you are a candidate, you will need to schedule a face-to-face consultation with our Specialist. In most cases, a tentative e-consultation can be arranged via email between you and our Physician. To learn more about this option, please contact The Hand & Wrist Center at (562) 424-9000.

Q: When and where is Needle Aponeurotomy performed?

A: Needle Aponeurotomy can be conveniently performed in our Office on the same day of your consultation, or on a separate day, if desired. With this procedure, there is no need to visit a surgery facility.

Q: Is anesthesia necessary for Needle Aponeurotomy?

A: Needle Aponeurotomy is performed under local anesthesia, which is administered via injection in our Office. During your procedure, you are completely awake. This is necessary so that our Physician can communicate with you during the progressive stages of Needle Aponeurotomy treatment. There is no need for general or intravenous anesthesia; therefore, there are no eating and drinking restrictions before and after your procedure. You can even plan to drive yourself to and from our Office the day of your procedure. If you are concerned about “being awake” for your procedure, our Physician will be glad to discuss alternatives for you.

Q: Can I have Needle Aponeurotomy performed at the same site(s) where I already had prior surgery, or prior Needle Aponeurotomy, performed?

A: Yes. Needle Aponeurotomy, a process of percutaneous penetrating of the soft-tissue layer (fascia) located directly under the palmar skin surface, can be performed at prior surgical (and Needle Aponeurotomy) sites. Because this procedure does not “repair” or “reconstruct” any of the underlying soft-tissue structures, and absent any other underlying conditions, it is deemed safe to repeat when it is performed by a trained Specialist.

Q: After Needle Aponeurotomy is performed, what can I expect?

A: Following your procedure, our Physician and Staff will provide you with specific instructions. In generally, you can plan on the option to drive yourself to and from our Office the day of your procedure. For the first 5-10 days following your procedure, you should plan to limit yourself from any heavy or forceful gripping, grasping and squeezing in order to allow the soft tissues to heal. Thereafter you should be comfortable enough to resume all of your normal daily activities. If any questions arise following your procedure, know that our Physician and Staff are always available to answer these questions for you.

Q: Is Needle Aponeurotomy covered by my insurance plan?

A: It is our Office policy to call your insurance carrier to pre-verify your benefits. Please know that most private insurance carriers, including Medicare, will not pre-authorize Needle Aponeurotomy. Our standard billing procedure, as instructed by most insurance carriers and Medicare, is to submit our claims with medical documentation regarding the necessity of Needle Aponeurotomy. Only then do most carriers review and determine if they will pay for Needle Aponeurotomy. In the event that your insurance carrier is unwilling to cover this procedure, our Office can discuss financial alternatives. You may obtain further detailed fee and insurance coverage information by contacting our Office at (562) 424-9000.

Q: Other than Needle Aponeurotomy, are there other alternative treatments for Dupuytren’s Contracture (Disease)?

A: Yes. As before Needle Aponeurotomy was introduced, one option is to undergo traditional, open (Fasciotomy) surgery, which is still a viable option for complex Dupuytren’s Contracture. If indicated, the specific approach for Fasciotomy is determined by our Surgeon at the time of your in-office consultation. A second, newer option is treatment via a collagen-based injection (Xiaflex™ by Auxilium), which was recently approved by the U.S. Food and Drug Administration in February 2010. Our Center is presently further analyzing the benefits and risks of Xiaflex. To learn more about Xiaflex visit www.xiaflex.com.

Q: Where can I find additional information about Needle Aponeurotomyand Dupuytren’s Contracture (Disease)?

A: In the Useful Links section of our website you will find Organizations that offer additional information for both topics.

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