Peter DeNoble, MD

09/06/2022

For all those baseball players out there!!

07/28/2020

07/27/2020

PERC TRIGGER FINGER RELEASE

A trigger finger can be annoying and VERY painful. It clicks and sometimes locks in a flexed or extended position. If a cortisone injection doesn’t fix it (it usually does), I can do this 5-minute procedure under straight local anesthesia right in the office and cure it once and for all!

Questions? Comment below or DM me 🙂

Modern Orthopaedics of New Jersey

07/21/2020

Fixing a 4th-of-July hand mishap on the 21st of July! Performed this procedure under (wide awake hand surgery) and we listened to ...always let my awake patients choose :). His fracture was already a little healed so I had to free up the fragment, put it back in place, then add some pins. Thx to for doing great and recommending the tunes!

07/20/2020

Are you sick and tired of your super painful TENNIS ELBOW? Here’s a solution I use for when all else (rest, bracing, injections) fails!

I really like the results I get from my arthroscopic ECRB debridement. Through a scope I can also address other intra-articular problems like synovitis, plicas, loose bodies, etc.

Questions? Comment below or DM me 🙂

Modern Orthopaedics of New Jersey
Modern Ortho of NJ - In the OR

07/16/2020

DISTAL RADIUS FRACTURE
+ VOLAR LUNATE FACET FRAGMENT

This patient has the misfortune of missing a step on her ladder while still 4-feet from ground... Ouch!

This was already an ugly wrist injury, but the snake in the grass here was the sneaky “volar lunate facet” fragment. This tiny but important piece of the fracture is attached to the volar wrist ligaments, and if not identified pre-operatively - and fixed intra-operatively - can be a source of fixation failure.

In her case, I used a volar plate for
the main segment, and then I secured the small volar lunate facet fragment (actually it was in 2 pieces) with heavy-duty sutures that anchored it in place, and therefore allow for early wrist range of motion - no pin, hook, or plate sitting at the teardrop to irritate the tendons.

Check out my intra-op video on this suture fixation technique at: Modern Ortho of NJ - In the OR

07/11/2020

One of the most serene, peaceful places I’ve ever visited... Las Conchas Trailhead, New Mexico. Was like we were walking through a painting. And to think we just stumbled upon it while taking the “scenic route” from Albuquerque to Sante Fe last July, where we were visiting for my annual hand surgery travel club meeting! So beautiful. Enjoy!!

07/04/2020

How I do an endoscopic carpal tunnel release, WIDE AWAKE - new 60 second video!

Minimally invasive,
Wide awake,
Safe and effective!

Modern Orthopaedics of New Jersey

06/29/2020

FINGER REPLANT - See The Reattachment Pix at Modern Ortho of NJ - In the OR

It only takes a split second to lose control of a circular saw - and have your hand end up in ours... fortunately David Ratliff and I were on-call this day and we performed a microsurgical replant of this young man’s small finger!

The key to these cases is being skilled and efficient - i.e. working with another skilled microsurgeon, planning a step-by-step order of repairs, and ensuring rapid restoration of blood flow. This patient had a wonderful outcome!

BONE
⬇️
EXTENSOR TENDON
⬇️
FLEXOR TENDON
⬇️
DIGITAL ARTERY (at least one)
⬇️
DORSAL VEINS (at least two if possible)
⬇️
DIGITAL NERVES
⬇️
SKIN

Modern Orthopaedics of New Jersey

06/22/2020

ANTERIOR CLAVICLE PLATING -
NERVE-SPARING TECHNIQUE

My 21 year-old patient was a front seat passenger in her friend’s car when an oncoming car slammed into them. Fortunately her seatbelt protected her head and the rest of her body...but also snapped her clavicle into several pieces! Due to the severe pain and bone displacement, we decided surgery was her best option.

Fixing a displaced collar bone (clavicle) has SEVERAL BENEFITS:

1. Instant bone stabilization = quick
improvement in pain and more rapid return to function.

2. More certainty that the collar bone will heal.

3. Restoring clavicle length avoids long-term shoulder deformity… and specifically helps to ensure proper shoulder function; in other words, it ensures that one leg of the “tripod" isn’t abnormally short.

I use a NERVE-SPARING ANTERIOR CLAVICLE PLATING technique for several reasons:

1. Preservation of the supraclavicular nerves -(the little dental floss-looking strings draping across the incision - see at Modern Ortho of NJ - In the OR) - I use meticulous care to dissect and protect these delicate structures while plating the clavicle. This can preserve skin sensation on the chest AND help prevent painful neuromas from cut or torn nerves.

2. While anterior plating is more technically challenging, this type of contoured plate is more cosmetically pleasing AND is often less irritating when it comes to wearing a bag or backpack strap over the shoulder!

Modern Orthopaedics of New Jersey

06/19/2020

06/16/2020

SHOULDER SUPERIOR CAPSULAR RECONSTRUCTION

Popularized over the past 5-7 years, this is a great procedure for patients who have pain and cannot raise their arm due to a massive rotator cuff tear that cannot be repaired.

In this case, David Ratliff assists me as I first measure and cut the alloderm graft. Next, all through a scope, we implant and anchor the graft over the top of the joint (which stabilizes it) and replaces the retracted and atrophied rotator cuff.

After this procedure, my patient had immediate improvements in her shoulder pain and regained the ability to raise her arm above her head during the 4-month course of post-op physical therapy!