Blog Archives

Blog Archives

Treating Hands and Wrists

Posted by on July 22, 2019

Our hands are constantly in use from the time we wake up until we go to bed. Pouring coffee, holding a steering wheel, typing, folding clothes, picking up children, and opening doors are just a very small array of tasks hands must accomplish each day. They’re called upon to complete unwieldy chores like picking up loads of firewood and also being asked to nimbly thread a needle. All is going well until you feel a pop in your wrist, or you jam your finger, or possibly suffer an unfortunate traumatic injury. When everyday function is limited, it’s hard to complete even the most basic of tasks.

Dr. Lee Hunter is the hand and wrist surgeon at Mid-Tennessee Bone and Joint. He has practiced for 22 years and joined MTBJ in 2002. According to Dr. Hunter, there are many conditions that can lead to pain in the hand and wrist. Some can be acute, like a fracture. Some conditions are the result of overuse or incorrect ergonomics, like carpal tunnel, De Quervain’s tendinosis, or trigger finger. And still others are simply due to age or genetics, like osteoarthritis. No matter the source of the pain, you want it gone.

In diagnosing hand and wrist pain, Dr. Hunter says obtaining a history from the patient and performing a physical exam, along with x-rays, are almost always necessary in order to determine the root causes of the pain. “Lots of patients come in thinking all hand pain is either carpal tunnel syndrome or arthritis,” he says. “Sometimes that’s the case, but a lot of time it isn’t.” Asking questions about the patient’s work environment, determining exactly how the pain manifests itself such as tingling or shooting, and inspecting the mechanics of the hand are all ways to help identify the patient’s condition.

One topic that usually gets a lot of attention when discussing hand or wrist pain is cracking knuckles. Everyone has heard someone say that it will cause arthritis, but what is the truth? According to Dr. Hunter, there is absolutely no evidence that habitually cracking knuckles causes any cartilage damage or arthritis. The sound may be irritating, but that is the only harm it will cause.

Dr. Hunter often sees injuries related to sports, specifically related to wrist and thumb ligaments. One such injury is called gamekeeper’s thumb and involves the ulnar collateral ligament. This is an injury of the soft tissue that connects the bones of the thumb together and happens when the thumb is pulled backward away from the hand, also described as the thumb being hyperextended. Sports injuries can likewise result in a fracture, for example, if you fall onto buy metformin hand. Jammed or dislocated fingers are also common sports injuries, indicated when the finger has a somewhat crooked appearance along with swelling and pain. Apply ice until you can see a doctor, who may recommend a splint or to “buddy tape” the injured finger to an uninjured one next to it.

Hand and wrist arthritis can be somewhat difficult to treat simply because the condition is often determined to be chronic, and if left untreated, can cause permanent injuries. But catching it early can mean more options when it comes to pain management and restoration of function. Arthritis pain typically presents with aching joints, morning pain and stiffness, fingers feeling tight, and bony lumps about the finger joints and wrists. Numbness is not generally a symptom of arthritis. Patients report feeling pain when performing everyday tasks such as opening bottle tops or jars, writing, or computer work.

The most common treatments for arthritis are nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and analgesics like Aspercreme and Icy Hot. These treatments vary in what they do to minimize the effects of arthritis. NSAIDs ease both pain and inflammation, corticosteroids are just used for inflammation relief, and analgesics are just for pain relief and are a good option for patients who are unable to take NSAIDs.

Partial wrist fusions are a common surgical treatment for wrist arthritis when the wrist has been damaged to the point that it no longer functions normally. The surgery allows the patient to preserve half or more of their wrist motion while providing predictable pain relief and restoring function. Total wrist fusions are much less common, but are an option for pain relief when necessary. Dr. Hunter also performs many thumb arthritis surgeries. They are very common and are performed for loss of function and pain at the base of the thumb where it joins onto the wrist. This particular surgery has very high patient satisfaction rates. Finger joint replacements, and in some cases fusions, also generally work very well.

Treatments also vary depending on the diagnosis. Dr. Hunter will often recommend cortisone injections as a first option for arthritis, but the injections have limited benefits in the thumb joint. In milder cases, a splint can provide temporary relief. Cartilage tears and ligament injuries within the wrist can often be addressed with arthroscopy. Carpal tunnel syndrome, trigger fingers, de Quervain’s disease, tendon and nerve lacerations, and Dupuytrens symptoms are all common hand and wrist problems that can require surgical treatment.

One topic that usually gets a lot of attention when discussing hand or wrist pain is cracking knuckles. Everyone has heard someone say that it will cause arthritis, but what is the truth? According to Dr. Hunter, there is absolutely no evidence that habitually cracking knuckles causes any cartilage damage or arthritis. The sound may be irritating, but that is the only harm it will cause.

Dr. Hunter is here to answer any questions you may have regarding hand or wrist pain. To schedule an appointment, call our office at 931-381-2663.

2019 Free Student Athlete Sports Physicals

Posted by on May 1, 2019

Every spring, Mid-Tennessee Bone and Joint provides free sports physicals for Maury County student athletes. This year, those physicals will occur on Monday, May 13 (boys) and Monday, May 20 (girls). Student athletes will need to bring the following paperwork with them for the physicals:

TSSAA Preparticipation Evaluation Physical Examination Form (link)

Students are to fill out their name and date of birth at the top of the form
The rest of the form will be filled out by the physician on site during the physical

MTBJ Preparticipation Physical Evaluation History form (link)

Parents/guardians and students are to fill out the form in its entirety prior to the physicals
Parents/guardians are to sign the bottom of the form. Without a signature, the student will not receive a physical.

View the schedule below:

Platelet Rich Plasma

Posted by on February 25, 2019

Platelet Rich Plasma (PRP) treatments have become an emerging trend in healing for a variety of orthopedic ailments. While social media is abuzz with the possibilities, the information being shared does not always line up with the realities of what PRP can do. The surgeons of Mid-Tennessee Bone and Joint are familiar with PRP treatments and know firsthand how they work and what the procedure is capable of.

Dr. Scott McCall has performed these specialty treatments in our office and in surgery. The procedure is relatively easy and takes approximately 10 minutes. Blood is drawn from the patient in a routine manner and put into a centrifuge to isolate the plasma. The plasma is drawn up into a new syringe and injected into the patient’s joint, much like receiving a cortisone or viscosupplement injection.

Dr. McCall says the patients who will most benefit from PRP are young and experience tendonitis or chronic inflammation in the knee, foot, elbow, or shoulder (rotator cuff). PRP has been shown to reduce inflammation in those areas and boost healing. Arthritis treatments have long benefited from steroids, such as cortisone, prednisone, and corticosteroids. PRP hasn’t been shown to be as effective in treatment of arthritis.

Even though PRP treatments have been soaring in popularity lately, the technology itself is not necessarily new. Dr. McCall has performed the treatments as part of his surgeries for the last eight years in patients with partial tendon tears. He injects the PRP intraoperatively during surgery to aid in healing and improve recovery time.

It is important to state that PRP is not proven to regrow any tissue, whether cartilage, tendons, or muscle. It also doesn’t help patients whose joints are bone on bone and could benefit instead from a total joint replacement. Additionally, PRP treatment is not a benefit that is currently covered by insurance. The cost of the procedure can vary and is paid out of pocket by the patient prior to the treatments.

Our surgeons are happy to discuss the possibilities of PRP to see how you can benefit. To schedule an appointment, call our office at 931-381-2663.

Visit our Specialties page to learn more about the various orthopedic services our physicians provide!

Cheerleading Safety

Posted by on January 23, 2019

While cheerleading once involved just leading cheers and chants with minimal tumbling and acrobatics, modern cheerleading has greatly evolved. It is much more competitive and involves a highly athletic mix of dance and gymnastic skills, as well as complex stunt and pyramid maneuvers. With these advances, the potential for severe injury has increased. Cheerleading accounts for more than 16,000 emergency room visits annually in the U.S. and more than half of the catastrophic injuries in female athletes. Cheerleading injuries are more likely to occur in practices and tend to involve the entire body — most commonly the ankle, wrist, shoulders, head, and neck.

In order to minimize the risk of catastrophic injury, restrictions have been placed on stunts. Mandates include limiting the height of human pyramid stunts, limiting the height in which a cheerleader may be thrown into the air for a basket toss, and a requirement for having a certain number of spotters on the ground during these acrobatics. Mats should be used during practice sessions and as much as possible during competitions. Stunts should not be attempted without proper training, and not until the cheerleader is confident and comfortable with performing the stunt.
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Concussions are another potential injury in cheerleading. A concussion is an injury to the brain resulting from an impact to buy strattera . Concussions are a risk for any athlete, but are a particular concern for those participating in cheerleading due to the nature of the activity involving height, inversion, and rotation of the body as well as physical interaction and contact with other team members. Players and coaches need to be mindful of any symptoms that arise after a fall, including headache, dizziness, or nausea.

As with any activity in which their child participates, parents have a role to play in ensuring that their child is able to reap the benefits that come with the activity while being protected from unreasonable risk. If a parent has a concern about safety, they should bring it to the attention of the coach. If a satisfactory response is not received, they should contact the administration to make sure proper procedures are in place for safety.

Cheerleading has become a sport that places significant demands on the body and can result in severe injuries. Proper attention to safety and preparation can help minimize injury risk.

Sources: and

New Tennessee Opioid Laws

Posted by on January 18, 2019

As of July 1, 2018, new laws went into effect in the state of Tennessee regarding the ways doctors are able to prescribe opioids to their patients. The changes were a direct result of a nationwide increase of deaths tied to opioid use, both prescription and illegal. According to the TN Together legislation, opioid related deaths in the US have quadrupled since 1999, and Tennessee remains in the top 15 of all states in drug overdose deaths.

There is no doubt those statistics are staggering, and it is not unreasonable at all to expect our elected officials to pass laws to save as many lives as possible. While it is too early to see a direct decrease in deaths related the new laws, the expectation is that more lives will be saved by reducing the amount of these prescriptions that are written.

There have been many questions surrounding these new laws and determining how patient care will be affected. We hope to provide some education and give patients a better understanding of what to expect for their course of treatment as a patient of Mid-Tennessee Bone and Joint.

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What is an opioid?
Opioids are a class of drugs that provide pain relief after a specific event. They are stronger than over the counter pain relievers. Common prescription names for opioids are Vicodin (hydrocodone), Ultram (tramadol), OxyContin or Percocet (oxycodone), Opana (oxymorphone), Kadian or Avinza (morphine), fentanyl and codeine. Heroin is another type of opioid that is not prescribed and is illegal.

When are opioids prescribed?
Opioids are prescribed to relieve moderate to severe pain after a surgery or serious illness. They are generally safe when used for a short time as prescribed, but misuse can be deadly. For most patients, three days or fewer will suffice, and only a small number of patients will require more than seven days’ worth.

What are the risks and side effects from opioid use?
While they’re beneficial for controlling severe pain, opioids can cause significant side effects when taken for prolonged periods. The most concerning has to do with risks of overdose and ensuring the prescription is taken in correct doses. Even when taken as directed, possible side effects include nausea, sleepiness, dizziness, and confusion. The risks for these side effects increase for patients who have existing mental health disorders, a history of drug abuse, or are 65 or older. It’s also incredibly important to avoid alcohol use while taking opioids. Mixing the two can depress the central nervous system, causing decreased breaths, unconsciousness, and death. The only solution to decreased drug usage or the complete cessation of drug usage, can be through a faith based rehab wherein therapy is used to reroute your addiction synapses.

What does the new law say?
The law looks at the opioid crisis from three sides – prevention, treatment, and law enforcement. Doctors now have stricter guidelines on prescribing opioids and must routinely check the Controlled Substance Monitoring Database which tracks how often a patient has been prescribed an opioid.

Per the new law, opioid prescriptions are written for specific amounts based on need:
• Initial prescription, written with minimal restrictions – 3 days’ worth.
• Patients who underwent a minimally invasive procedure – 10 days’ worth.
• Patients who underwent an invasive procedure – 20 days’ worth.

Other requirements:
• For larger doses, prescriptions are only to be filled for half of the initial amount.
• Doctors must document specific need for increased supply.
• Patient must sign informed consent form agreeing that the physician outlined all of the risks and concerns in taking opioids.

These new requirements were written based on research into the reasons behind opioid abuse. For instance, a 10 day prescription of an opioid may only be filled five days’ worth at a time. The reason for this change goes back to studies that show most people who abuse opioids get the pills from someone else, whether from an active prescription or an old one where all of the pills were not taken. By dispensing only half of the pills at once, the aim is to reduce the amount of leftover medication. If the remaining five days’ worth is legitimately required, the patient just needs to return to the pharmacy for the rest.

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Are there exemptions?
There are very few situations in which larger or prolonged doses are allowed. If a patient is undergoing cancer treatment, is in hospice care, has been diagnosed with sickle cell disease, or for those patients who are at an in-patient facility such as a hospital, nursing home, or assisted care facility, then they are not part of the above restrictions. Additionally, patients who have experienced severe burns or major physical trauma and patients who are under the care of a healthcare professional for an opioid use disorder also qualify as an exemption to the new laws. As these exemptions are tied to very rare circumstances, we do not expect our patients will fall into a category in which an opioid prescription will be written.

How does MTBJ handle opioid prescriptions?
Typically, any opioid prescriptions will be reserved as an option for our patients who undergo surgery. Our physicians believe more education is vital when it comes to understanding the role opioids play in pain relief, and that better education about pain will help our community in the long run. Our goal is to manage our patients’ expectations about how much pain they should experience in the first few days after surgery and that it will get better.

As always, Mid-Tennessee Bone and Joint will continue to appropriately utilize a variety of therapies as we always have to address our patients’ pain. We pledge to diligently abide by these new federal opioid laws while continuing our great tradition of specialized, compassionate, and exceptional care.

Click here to read more articles from the Fall/Winter OrthoConnexion.

AC (Acromioclavicular) Joint Separation Injury

Posted by on January 15, 2019

Duke men’s basketball point guard, Tre Jones, suffered an AC Joint Separation this week and is reported to be out indefinitely. The injury happened due to a collision with an opposing player, with Jones bearing the brunt of the crash’s force to his right shoulder. It’s a painful injury that can be treated non-surgically or surgically, depending on the severity.


With this injury, the collarbone separates from the shoulder blade. It can range from a mild sprain to a complete ligament tear. To read more about this injury, visit OrthoInfo – Shoulder Separation as part of the American Academy of Orthopedic Surgeons.

For more information on the shoulder injuries we treat at Mid-Tennessee Bone and Joint, visit our shoulder page.

Christmas Door Decorating Contest!

Posted by on December 7, 2018

Our associates teamed up again this year to decorate doors around our clinic, and as you can tell from the photos below, we have some very creative people! We worked during lunch and after hours to create our masterpieces, and the results were well worth the extra time spent. Our first, second, and third place entries are below along with the rest of the doors. Let us know which one was your favorite!

1st place

2nd place

Tied for 3rd place

Tied for 3rd place

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MTBJ Donates to Harvest Share

Posted by on November 28, 2018

For the fourth year, Mid-Tennessee Bone and Joint associates have collected food donations to support Harvest Share Food Pantry here in Columbia. Over the span of four weeks, we collected more than 2,000 items that will go directly to this worthy organization.

The mission of Harvest Share is to provide food and comfort to those unable to help themselves. To date, Harvest Share has distributed thousands upon thousands of pounds of food to the starving men, women and children of Maury County. Their primary goal is to wipe out hunger in our community.

Just as our clinic has been blessed, we understand what a privilege it is to be able to bless others!




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Happy retirement, Elaine!

Posted by on November 10, 2018

We are celebrating the 43-year career and recent retirement of our colleague Elaine Alderson. Elaine was the first employee when Mid-Tennessee Bone and Joint opened its doors in January 1975.

MTBJ 020916-007 Elaine_web

Known as “Mama Elaine” to our staff, she graduated from Santa Fe High School in 1967 as Valedictorian and began working as a legal secretary for then-Columbia law firm McFarland and Colley. She stayed home until her son started school and around that time is when Dr. Eslick Daniel was starting his new orthopedic practice in Columbia. She was hired by Dr. Daniel and stayed for over four decades. She retired as the office Business Manager, taking care of accounts payable and stepping in when needed to manage scheduling, employee payroll, and insurance.

Elaine has seen many physicians come through these doors, lived through several moves to different offices, and through it all stood strong as the familiar face everyone looked forward to seeing each morning.

Retirement party Elaine Kenneth

Elaine exemplifies honesty, trustworthiness, and a willingness to do whatever it takes to get the job done. We are sad to see her go, but we are forever grateful for her tenure here! Congratulations, Elaine!

Dr. Randy Davidson Elected President of Campbell Club

Posted by on October 26, 2018

Dr. Randy Davidson was introduced as the next president of the Campbell Club at mtbj_photos-071-davidson_web-cropthe Campbell Clinic triennial meeting on October 5th, 2018, in Memphis, Tenn. He will buy accutane in this position from 2019-2021. The Campbell Club, the alumni association of Campbell Clinic, was founded in 1946 and includes graduates of the residency and fellowship programs, as well as associate members who serve on the staff of Campbell Clinic. There are more than 470 former residents and fellows involved in both academic and private practice all over the United States, Canada, South America, and Europe. Congratulations to Dr. Randy Davidson on this new position!


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