Ask The Expert: Dr. Jeffrey Klugman, Hand Surgeon

Dr. Jeffrey Klugman hails from Philly.  Our mild winters coupled with Atlanta’s friendly people caught his attention and The Hand and Upper Extremity Center, where his medical practice is based, sealed the deal. Although he has yet to switch his love for the Philadelphia Eagles to the Atlanta Falcons, we are honored and thankful that Dr. Klugman calls Atlanta home. Always up for a challenge — when he’s not teeing up on the golf course or building LEGOS with his beloved son Harris or his enjoying a tea party with his cherished daughter Samantha — he’s conferring with his patients and executing incredibly skillful procedures for both children and adults in the operating room. 

     A surgeon’s life is intense and when it’s time to relax, he loves to travel and high on his list of favorites are African safaris, journeys to Israel and beach getaways, all together with his incredible wife Robyn. His family’s favorite destination is Margate City on the Jersey shore; he’s been vacationing there since he was a child. One of Atlanta’s and the Southeast’s foremost experts in hand surgery, known for his acumen with both children and adults, his services are in very high demand. He’s the crème de la crème, one of the most sought after and specialized hand surgeons in the South; we are lucky he made Atlanta his home.

     Dr. Klugman’s prestigious resume includes graduating from Tufts University School of Medicine in Boston where he  was selected for the Alpha Omega Alpha Medical Honor Society; a residency in orthopedic surgery at the world-renowned NYU/Hospital for Joint Diseases Orthopedic Institute and a distinguished Harvard University Hand Fellowship at Brigham and Women’s Hospital, Boston Children’s Hospital and Massachusetts General Hospital.

    Dr. Klugman has authored multiple publications and is active in training residents and fellows. He holds a Certificate of Added Qualification in Hand Surgery and is a member of the American Society for Surgery of the Hand and the American Academy of Orthopedic Surgeons. 

TG: Dr. Klugman, you treat both adults and children. How can you help newborn infants with congenital deformities? 

JK: My partners and I have a special interest in pediatric hand surgery and we are often asked to see children with congenital differences. These patients require specialized care and attention as these often are unique problems. Time must be spent in discussion with the family so they can understand the medical issues, treatment options to improve function and cosmesis (preservation of bodily beauty), timing of treatments, and long-term prognosis.

    Congenital issues affect the child but also have an impact on families. Treatments can include therapy, splints, comprehensive medical work-ups, and surgical intervention. Our practice supports a Pediatric Hand Fellowship through the Children’s Healthcare of Atlanta System to hopefully educate future clinicians in how to manage these difficult problems. 

TG: What other pediatric hand problems do you commonly treat?

JK: There are a wide variety of pediatric hand issues. Trauma, such as fractures of the wrist, hand, and fingers, are the most common. I see a large volume of wounds and lacerations often involving tendon and nerve injuries. Masses and cysts are also frequent problems. We care for recreational to high-performance athletes with traumatic injuries, sprains and overuse problems. Crush injuries, finger tip injuries, congenital trigger thumbs/fingers and inflammatory problems, are also quite common.

TG: Let’s talk about your life-changing work with adults. How soon do you like to see a patient after their initial injury?

JK: Often after an acute injury people are seen at an ER or an urgent care. Other times, injuries may be less severe. I believe with injuries of the hand/wrist/forearm it is best to be seen early. Problems are easier to treat when they are more acute. Fractures may heal with malalignment or displacement if not treated properly, and tendon injuries often have a strict time line associated with repairs that dramatically affects outcomes.

    In addition, ER and urgent care MDs are not specialists so it is not uncommon for them to not fully appreciate the severity of an injury or miss subtle issues. Coming for an evaluation early allows for a more accurate and effective treatment with improved outcomes. If the injury is not severe, then patients can be reassured and encouraged to progress with motion and functional activities to prevent stiffness and other complications.  

TG: Arthritis is a common problem. I can remember my mother suffering with arthritis both via pain and the shape of her fingers. Are there any new solutions? 

JK: There are multiple types of arthritis such as osteo, rheumatoid, post traumatic, septic, etc. It sounds like your mother had osteoarthritis. This is a very common problem affecting the hands more so in women than men. It is typically a genetically pre-programed process, meaning it affected your grandmother, mother and will likely affect you. Arthritis of the hand can result in deformity, stiffness and pain.

    Unfortunately, there is no way to prevent this process from occurring or progressing in patients with a pre-disposition. There are options to help with function and cosmesis. Arthritis of the thumb base is a particularly common problem we see that can be painful and functionally limiting.  Fortunately, there are good options available to treat this issue and dramatically improve both pain and function. Non-surgical treatments can include steroid injections, a variety of splits, and nonsteroidal anti-inflammatory medications.  Outpatient surgical treatments can often provide a more permanent solution.  

TG: Is there a treatment for carpel tunnel syndrome? Many people, especially in our computer age, suffer from this malady. Please also tell us about Trigger Finger — what is it and can it be treated?

JK: Carpal Tunnel Syndrome is among the most common problems I see. Carpal Tunnel is compression of the median nerve as it traverses from the forearm into the hand. The carpal tunnel is a defined space with three side bones and a dense ligament forming the roof of the tunnel. When pressure increases in the space it causes the nerve to become compromised and this results in numbness to the thumb, index, middle and part of the ring finger. It can also cause weakness to the muscles at the base of the thumb, which significantly affects fine motor function.

    Patients with Carpal Tunnel Syndrome often require an EMG/Nerve conduction study to objectively evaluate their complaints. Treatment can include a variety of non-operative measures as well as carpal tunnel release surgery, which has a very high success rate in improving symptoms and preventing them from worsening or recurring over time.     

Trigger finger is another common problem I often treat in my office. Trigger finger results from inflammation and catching as the flexor tendon glides through the sheath and first pulley that keeps the tendons adjacent to the bone. In a trigger finger, the tendon becomes inflamed and catches at the first pulley creating a mechanical block, like a truck that’s too big to fit through a tunnel. The solution is to make the truck smaller with a steroid injection or, if that does not solve the problem, I can permanently make the tunnel bigger with a small outpatient procedure to release just the first pulley. Trigger finger release surgery is very effective with high patient satisfaction and minimal down time.  

TG: What separates a hand surgeon from an orthopedic surgeon or plastic surgeon? 

JK: Hand surgeons are typically orthopedic or plastic surgeons who do additional fellowship training specifically in hand surgery. The hand is an extremely complex area anatomically. I tell patients the hand is like Manhattan, lots of expensive real estate in a small area. I believe subspecialization allows for more accurate diagnosis, improved treatment options, more effective therapy and overall improved outcomes.

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