Hand and Upper Extremity Surgical Expertise

Stephen J. O'Connell, MD (left) and Jacob Bosley, MD
Now, in its 43rd year, Eisenhower Desert Orthopedic Center (EDOC) is one of the busiest practices of its kind in Southern California — a depth of experience that translates into optimal patient outcomes. This expertise is particularly evident in the subspecialty of hand, wrist and shoulder surgeries.

Stephen J. O’Connell, MD, is a fellowship-trained Board Certified Orthopedic Surgeon specializing in hand and shoulder surgery. Today he is President and Chairman of the Board of Desert Orthopedic Center, and Director of the Hand and Upper Extremity Program.

“What appeals to me about this specialty is its complexity and its creativity,” says Dr. O’Connell “In the hand alone, we perform more than 100 different operations that may involve the repair or reconstruction of bone, blood vessels, nerves, tendons, ligaments and joints.”

When asked to describe an example of a complex case, Dr. O’Connell recalls a patient with an amputation of thumb and index finger.

“The thumb had been totally destroyed, but the index finger was still viable,” explains Dr. O’Connell. “I was able to replant the index finger in the position of the thumb to make it a functional thumb, so the patient had an opposable digit to pinch against.”

Not all of the hand and upper extremity surgeries performed at EDOC are so complex, however. In fact, most of the procedures are more routine, at least to experienced specialists like Dr. O’Connell and colleague Board Certified Orthopedic Surgeon Jacob Bosley, MD. They include fracture repairs, repair of the base of the thumb joint, carpal tunnel release, trigger finger releases, tennis elbow operations, and rotator cuff reconstructions.

“We treat 600 wrist fractures a year, often using internal fixation with tiny plates and screws, says Dr. O’Connell. “With today’s techniques, patients can avoid a rigid cast and instead wear a splint, enabling early soft tissue rehabilitation while the bone heals.”

Minimally invasive techniques

Advances in surgical technology and techniques mean many hand and upper extremity surgical procedures are now performed using minimally invasive techniques. For example, a newer approach to performing thumb joint replacement called suture suspension arthroplasty facilitates faster recovery for people with thumb arthritis.

“Endoscopic carpal tunnel release, a minimally invasive procedure of performing carpal tunnel surgery using an endoscope or an open mini release also helps people return to their regular activities faster than the traditional open surgery,” says Dr. Bosley.

“Carpal tunnel syndrome and trigger fingers are some of the most common problems we see with patients experiencing such pain relief, they invariably wonder why they didn’t have the surgery sooner,” Dr. Bosley states.

According to Dr. O’Connell, having expertise in the entire upper extremity — hand, wrist, elbow and shoulder — enables them to better diagnose complex upper extremity problems.

“Many shoulder problems may present as pain in the arm, while problems such as carpal tunnel syndrome may present as pain in the arm and shoulder,” explains Dr. Bosley. “Having expertise in the entire upper extremity allows us to determine the origin of the problem and create a treatment program best suited for that individual patient.”

Dr. O’Connell and Dr. Bosley are both fellowship-trained orthopedic surgeons but also have an additional board qualification in hand surgery. Dr. Bosley joined EDOC just over a year ago to meet the high demand for upper extremity expertise in the desert.

Dr. Bosley recalls a recent difficult case of one desert resident. “I was referred to a 70-year-old patient who had been attacked by a dog,” says Dr. Bosley. “She suffered a complex injury to the skin and tendons, plus severe fractures to both bones of the forearm. She also had an infection from the dog bite. Following several surgeries, including repair of the tendons and bones and debridement for the infections, I was able to help the patient obtain excellent function and strength of her hand.

“It was very satisfying to assist this patient in regaining her ability to take care of herself and perform the activities she desired.”

Timely access

“We are very busy and much of it has to do with offering timely access,” says Dr. O’Connell. “Many surgical problems are traumatic experiences and need to be treated promptly. Procedures such as arthroplasties [joint replacements] may be done electively.

However, acute injuries such as fractures, nerve injuries, vascular injuries, and tendon injuries need to be performed promptly to achieve the best outcome. With Dr. Bosley on board we now have the additional capacity to handle these situations in a timely fashion.”

While they are surgeons, Dr. O’Connell and Dr. Bosley stress that there are numerous hand issues that do not require surgical intervention.

“Just because you see a surgeon, doesn’t mean you have to have surgery,” Dr. Bosley says. “We offer a range of conservative treatment options, such as corticosteroid injections, biologic injections, Xiaflex® injections for Dupuytren’s contracture and various forms of splinting and occupational therapy to improve a patient’s function.”

If surgery is necessary, however, it will soon be performed in a new surgery center now under construction as part of the 50,000- square-foot addition to the Harry and Diane Rinker Building, home of EDOC on the main Eisenhower Campus in Rancho Mirage. Including eight state-of-the-art operating rooms and facilities for overnight patient stays, it is slated to open in December 2020.

Dr. O’Connell credits the generosity of Eisenhower’s philanthropic community for making this new surgery center possible.

“Modern, well-equipped facilities with outstanding, fellowshiptrained orthopedic surgeons will help us provide top quality orthopedic care to the community and also attract top orthopedic surgical talent to our group,” says Dr. O’Connell. “Our staff, together with the state-of-the-art facility, allows Eisenhower Desert Orthopedic Center to be truly a center of excellence.”

To contact Eisenhower Desert Orthopedic Center, call 760.773.4545.