Orthopedic and Sports Medicine in Seattle

In his practice, Dr. Peterson diagnoses issues relating to all parts of the skeleton, and in particular those maladies of the shoulder, elbow, hip, and knee. He provides both complex and minimally-invasive arthroscopic surgery, total joint replacement of the shoulder, elbow, hip, and knee, as well as fracture care and sports medicine.

Dr. Peterson sees patients from all around the Northwest and Canada. He admits patients to Swedish Medical Center, and has two offices in north Seattle. If you would like to make an appointment at either the Wallingford or Ballard office, please call 206-633-8100.

Trigger Finger-Symptoms, Treatment, and Surgical Release

Trigger finger is a common condition that results in pain and snapping of the tendons at the base of the finger or thumb. These tendons are like pulleys that attach to the ends of the fingers to allow for finger movement. As the forearm muscle contracts, the tendons pull each finger into a fist. With trigger finger, this mechanism is not smooth and a snapping sensation can be felt, causing pain.

What causes trigger finger to occur?

The cause of trigger finger not clear, and this condition can appear without any particular cause. It is thought to be genetic and often occurs in one or more fingers and at different times in different locations. Trigger finger results from a difference between the size of the tendon and the entrance to the tendon sheath, usually at the base of a particular finger. … read more

Carpal Tunnel Syndrome, Prevention, and Treatment

Carpal Tunnel Syndrome is a common condition that occurs when the median nerve is compressed at the wrist, resulting in pain, numbness, and tingling of the hand and fingers. The carpal tunnel is a tight area of the wrist that many important tendons and nerves pass through. It has a floor, walls, a ceiling, an entrance, and an exit. The floor and walls of the tunnel are made up of the bones.

Carpal Tunnel Syndrome, Prevention, Treatment The ceiling is the transverse carpal ligament. The median nerve runs from the forearm to the hand and directly through the carpal tunnel. This nerve controls some of your hand muscles and also allows sensation of your thumb, index, middle, and half of your ring finger. When this nerve is pressed and squeezed, carpal tunnel syndrome develops.

What are the symptoms of Carpal Tunnel Syndrome?

There are nine tendons that pass through the carpal tunnel and these attach muscles of this area to bones to allow your your thumb and fingers to flex. Each of these tendons has a slippery covering called the synovium. This covering allows the tendons to slide easily as the fingers are moved.

When the synovium becomes inflamed or thickened, pressure develops on the median nerve, adversely affecting its function. With a compromised median nerve, there is less blood and nutrients available, leading to numbness, weakness, and pain of the fingers and thumb. These symptoms are considerably worse at night or while driving. … read more

Exciting New Advancements in the Treatment of Dupuytren’s Disease – Xiaflex, Needle Aponeurotomy, or Surgery

Dupuytren’s Disease – What is it? 

Dupuytren’s contracture is an abnormal  thickening of the tissue just beneath the skin of the hand. You may notice thickening, pitting of the skin of the palmar skin and often the fingers can become contracted, making simple tasks difficult such as placing the hand flat on a table or placing a hand in a pocket. 

Usually, the condition is painless, though occasionally the initial presentation is accompanied by pain and inflammation. It is important to note that the underlying tendons and nerves are not directly involved, however, the nerves and vessels often become entrapped in the contracture, making treatment difficult.

Dupuytren’s Demographics

Fortunately, there are several exciting new treatments in the treatment of Dupuytren’s contracture.  I will describe the treatments in detail shortly, but in short, the cords need to be released if the finger is to be straightened.  The usual patient with Dupuytren’s contracture is over 40 and of Northern European descent. There is usually no associated injury or occupational exposure and the likely cause of Dupuytren’s contracture appears to be genetic.

Dupuytren’s Symptoms

The ring and small fingers are most commonly affected, with lumps and pits in the palm and progressive contracture of the hand. The cords often feel like tendons and usually hand function is unaffected until the fingers become curled. Initially, the nodules can be painful, but this usually resolves. Unfortunately, progression of the disease is unpredictable.

State of the Art Treatments for Dupuytren’s Contracture

At Orthopedic Specialists of Seattle, we offer all of the state of the art treatments for Dupuytren’s disease. First and foremost, a proper diagnosis is essential and usually I can help rule out other conditions, such as trigger finger, arthritis, or other similar conditions.

Traditional treatments include surgical resection of the diseased fascia. This is nearly universally successful for the resolution of the contracture, which is quite rewarding. The downsides to open resection include need for surgery, extensive rehabilitation, and a moderate recurrence rate of 10-15%. I perform this surgery routinely with excellent results.

Xiaflex injections are also an exciting new treatment which consists of injection of the cords with an enzyme which breaks down the cords over the course of 24-48 hours, allowing for manipulation of the fingers into a straightened position. The downsides currently are the cost ($3000/injection) and again, the recurrence rate higher than that of open surgery. We at the Orthopedic Specialists of Seattle offer Xiaflex injections.

Finally, there is an in-office procedure called a needle aponeurotomy, which is an impressive, relatively painless procedure where I am able to disrupt the cords in a single office visit.  This procedure has relatively small costs, is relatively straight forward and successful in my hands.  The downsides are simply the recurrence rate, again somewhat higher than open surgery.

If you are interested in this procedure, it is worth letting our front office know that they should set up a double appointment, to allow for the possibility of performing the procedure on the same office visit. It might be worth sending me a note explaining your condition and I can help facilitate a reasonable amount of time for your visit

If you have Dupuytren’s disease and would like to discuss your contracture, do not hesitate to call 206-633-8100 or contact me.

A Guide to Arthritis

What is arthritis?

Arthritis Guide and TreatmentThe word “arthritis” simply means “joint inflammation.” Inflammation involves pain, swelling, and stiffness of the joint area. When arthritis occurs, these symptoms tend to last for a long periods of time or reoccur over time.

Arthritis is very common, and most cases of arthritis lead to tissue damage. It has been estimated that as many as 70 million Americans (or one out of three people) have some form of arthritis or joint pain. Arthritis can affect persons of all ages but it is more commonly seen in older adults. … read more