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Conditions General Hands

Dealing with Psoriatic Arthritis of the Hand

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A lot of people know about osteoarthritis and rheumatoid arthritis, but not many realize that you can develop arthritis from the skin condition known as psoriasis. Psoriatic arthritis of the hand is somewhat rare, with around five to twenty percent of people with psoriasis developing arthritis related to it. However, it is common enough that it is very useful for anyone with psoriasis to learn about it, and its symptoms.

What Happens When You Have Psoriatic Arthritis?

If you have psoriasis, you are well aware of its appearance. Your skin takes on a very dry and scaly look, and it can often appear as if you have rashes in many areas of the body. The condition does tend to cause prolonged or even constant irritation to the skin, and it is this sort of irritation that eventually leads to the development of arthritis in the underlying bones and cartilage.

Because arthritis, which means “inflamed joint”, is something that can be due to chronic inflammation, it makes sense that psoriasis might eventually cause problems in the hands and wrists, where it is so prevalent. It does many of the same things that other forms of arthritis do when it does appear in the hands, and will lead to swelling, deformity of the joints, and a lack of stability in the wrist. The swelling of this condition, though, is more pronounced than any other form of arthritis (MayoClinic, 2015).

This is all due to the fact that the psoriatic arthritis is actually causing the lining of the joints to swell and to then degrade and allow bones to erode and rub against one another.

Many patients with psoriatic arthritis display many similar symptoms as those with rheumatoid arthritis. Their hands will appear swollen and with a red discoloration. They can be warm to the touch and will often have difficulty with stiffness and movement. However, unlike rheumatoid arthritis, psoriatic arthritis is usually asymmetrical (meaning it may appear on one hand and not the other), it causes skin lesions, and it tends to strike the PIP and DIP joint (the middle and end joints), rather than the middle joints or the wrist areas.

Diagnosing and Treating Psoriatic Arthritis

You must visit a hand doctor if you suspect that your psoriasis has now caused you to develop arthritis, especially if others in your family already have this condition. The physician will do a thorough history and exam. They may order a few tests and X-rays to determine if you do have the condition.

Should you be diagnosed with it, your doctor is going to focus on pain relief, alleviation of the swelling and inflammation, and function as the goals of treatment. This means you will work with more than just the hand doctor and may find yourself working with a therapist as well as other specialists. Medications and ongoing therapies are usually the most conservative treatments, and a hand doctor is likely to refrain from surgery until it is absolutely necessary. This is because it is a progressive issue, and surgery may be used as an intervention rather than an initial treatment of symptoms.

Dont hesitate to contact your doctor simply because the sooner you begin your treatment, the better the outcome.

Source

MayoClinic. Psoriatic arthritis: Symptoms. 2015. http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/symptoms/con-20015006

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Conditions General

Dealing With Olecranon Bursitis

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You may have heard of a condition known as tennis elbow, but did you know that there is one called “students elbow”? (Patient.co.uk, 2015) Also known as olecranon bursitis, it is when the small sac of fluid, known as a bursa, that covers the elbow becomes irritated and fills with fluid.

The bursa over the elbow is in place to allow the skin to move easily over the joint. When in a healthy condition it is flat and unnoticeable, but when it fills with fluid it becomes extremely noticeable and can be uncomfortable. Interestingly enough, not all instances of olecranon bursitis cause pain or discomfort at all.

Why Did I Get This Condition?

What is the cause for this unusual swelling at the elbow? Generally, it is caused when the area is irritated. This can mean that a hard blow to the elbow occurred and the sac has filled with fluid due to that injury, but it gets the name “students elbow” because it also commonly occurs in those who lean heavily on their elbows for long periods of time – as in the way that many students put elbows on their desks while listening to teachers or studying.

Of course, students arent the only ones prone to leaning overly long and heavily on their elbows. Telephone operators, long distance drivers, exercise instructors and people in gyms, computer workers, and many people with “desk jobs” may find themselves putting their elbows on hard surfaces and applying too much weight or pressure.

Additional causes include certain diseases such as rheumatoid arthritis, or conditions like gout. Medical treatments like dialysis have been known to trigger olecranon bursitis, and infection is also a common cause – such as a cut to the elbow. Finally, there are also idiopathic cases where no cause can be uncovered.

Generally, it is the swelling that allows someone to discover they have the condition, and though mild swelling may be present there are also many cases in which the swelling can reach the size of a small golf ball.

Treating Students Elbow

Diagnosing the condition is straightforward, though a thorough medical history is taken to be sure it is not related to one of the diseases that olecranon bursitis is commonly related to. Should disease be present, this first must be managed before treatment for the swelling is done.

Generally, the most common course of action is to refrain from any further leaning or pressure on the joint. In some cases a “resting splint” is used to prevent further irritation, and compression may also be used to help alleviate fluid accumulation.

Should the swelling be too substantial, a physician may decide to remove fluid through an aspiration technique. This is commonly an in-office procedure that is followed up by antibiotics to prevent or remedy an infection. Should the condition prove difficult to manage or overcome, there are surgical and medical options such as cortisone injections and ongoing aspiration.

The key is to not ignore olecranon bursitis. It may seem like a harmless bit of swelling, but it should not be ignored. Your hand surgeon or specialist can help you deal with the condition and prevent it from becoming a problem.

Source

Patient.co.uk. Olecranon Bursitis (Students Elbow). 2015. http://www.patient.co.uk/health/olecranon-bursitis-students-elbow

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General Treatments

A Look at Tendon Transfer Surgery

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In a report on hand tendon transfers, a group of physicians explained how this amazing treatment can be used to, “Create major improvement in the function of the extremity”, and that it was able to restore function in a new location. (Baumeister, et al, 2015).

Obviously, this makes tendon transfer surgery sound somewhat miraculous, and to those who need it and receive it, it truly can be. It is a surgical procedure in which a functional section of tendon is moved from its normal, natural position and attached to a new location in order to help restore function to that particular area.

It is as complex as it sounds and yet hand surgeons rely upon it for a long list of patients:

  • Babies born without specific muscle functions can benefit from tendon transfer surgeries.
  • Patients with nerve injury may benefit from the ability to use muscles disabled by the damaged nerves.
  • Muscles that have been lacerated or ruptured (and which are beyond repair) can benefit from the procedure.
  • Tendons damaged beyond repair can be replaced with a transfer.
  • Patients with nervous system disorders may lose muscle function, and yet tendon transfers may help them to regain some use of certain hand functions. This includes patients with traumatic brain injuries and stroke.

Clearly, this is a very useful procedure that can be a far more amenable option than many alternatives. For instance, the tendon transfer surgery can easily be used instead of surgery attempting to repair a nerve or muscle.

How a Tendon Transfer Surgery Works

It is difficult to summarize such a complex procedure, but to keep it a simple as possible: when a hand surgeon is going to use a tendon transfer, they begin by altering the point of contact between the tendon and the bone on which it originally resided. In its natural place, the tendon would always connect to a group of muscles that are, in turn, connected to their point of origin. In tendon transfer, the muscles are left alone, and it is the end point or terminus of the tendon that is altered.

The new connection point is chosen in order to create a very specific outcome. This is because the tendon can be attached to a different bone or tendon. This will allow the muscles to “fire” as normal, but their functions will now produce a different action or outcome.

This is why some stroke patients who have limited movement in the hands can have the most important functions, the pinching function, restored through a tendon transfer. This allows whatever muscle and nerve function remains to provide the pincer fingers with the ability to grip and move at will.

Your hand doctor will be able to determine if a tendon transfer is the best surgical solution for your needs. You will need to heal for a period of two months or more, get therapy to ensure the hand functions properly, and follow a rigid course of rehabilitation to get the best outcomes. However, the prognosis for most patients is usually good, and this procedure can provide you with a return of function that may have been lost.

Source

Baumeister, Steffen, et al. Hand Tendon Transfers. 2015. http://emedicine.medscape.com/article/1286712-overview

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General

How Your Hands Reveal Systemic Diseases

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Whenever you see a thorough description of any systemic disease, which is, “One that affects a number of organs and tissues, or affects the body as a whole,” it will usually list a lot of the key indicators for diagnosing the disease in question. For example, we may read that disease of the liver can cause issues in the skin and the fingernails. This is often a surprising “symptom,” and yet many problems manifest in the hands.

Because our hands include so many different types of tissue – skin, nerves, bones, blood vessels, tendons, and ligaments among them, it is actually not a surprise that so many systemic diseases reveal themselves in the hands. Just consider the following issues and how they can begin to help a medical expert diagnose a deeper or broader condition:

Buergers disease – A disease that impacts the small arteries, it can often cut off the blood supply to the fingers. This can result in ulcerations, as well as gangrene.

Clubbed nails – Some endocrine diseases as well as heart and lung conditions can cause the fingernails to take on an uneven and clubbed growth pattern.

Diabetes – Because this is a disease of the endocrine system, it often has an impact on the ligaments and tendons of the body. The condition known as trigger finger locks the finger into a curved position (with the tip pointing towards the palm), and causes substantial pain and discomfort. It is often a key indicator that the individual also has diabetes.

Gout – We most commonly think of gout as something that manifests in the foot, particularly the “big toe,” but this condition can affect any digit. In the hands, the condition reveals itself in several ways, and may cause the skin to thin and drain, taking on an infected look. It can cause bone changes, and most often presents as “pincer nail”, which leads to an ingrown nail and nail deformity.

Kidney and liver diseases – The skin and nails are affected by many kinds of kidney or liver diseases, and one common issue is known as Terrys Nails in which the area under the nail loses its healthy pink coloration and becomes milky white.

Raynauds disease – Also called a phenomenon, this is a condition in which arteries in the fingers spasm, preventing blood flow and leading to a bluish discoloration of the fingertips. This is a problem for those with lupus and scleroderma, but is also related to rheumatoid arthritis as well. If left untreated, it can lead to ulcerations and further health problems.

Rheumatoid arthritis – Usually, the first signs of rheumatoid arthritis appear in the fingers and hands. Though this is a whole body condition that destroys the tendons, joints, and ligaments, it seems to always manifest strongly in the hands. It can cause tendon rupture and loss of mobility, and is a good indicator that arthritis is developing.

Clearly, there are many signs and symptoms that you can receive through your hands and fingers. Dont ignore any new problems with the hands, and if you notice something very unusual, do not hesitate to visit your hand specialist for an assessment of what is going on.

Source

Wikipedia. Systemic disease. 2015. http://en.wikipedia.org/wiki/Systemic_disease

Categories
General Hands

Nerve Injuries of the Hands

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If there were some sort of illustration that showed us how much of our brains functions went to operating the hands, it might astonish you. A huge amount of communication and activity between the hands and the brains occurs each day of your life, and when there are nerve injuries it can be tremendously disruptive to your ability to function completely.

As the American Society for the Surgery of the Hand indicates, the nerves are like a “telephone wiring” system in the body which sends and transports messages from the brain and out to every possible location. Just as in a real world setting, if those lines are damaged or downed in some way, communication ceases and messages cannot head back and forth as usual.

Nerves are also, physically, a lot like phone lines with their outer protection and their many inner lines and fibers. Additionally, the various inner lines have different tasks, too, and there are motor nerves for making your body move, sensory nerves that indicate everything from pain to temperature. Any nerve fiber can carry only one message – either sensory or motor, but all nerve tissue is made up of both types of nerves.

Should a nerve be harmed due to injury, pressure, crushing, or stretching, all of the messages stop, too. This can leave you unable to move a limb or experience sensation or feeling in the area where the nerve once communicated. Interestingly enough, the part of the damaged nerve that is closest to the brain does not die when injured. It remains alive and can continue to function and even grow. Though this can develop into a painful condition known as neuroma, it also means that a nerve that has been damaged does have a chance at being restored.

Can Damaged Nerves Come Back to Life?

If a nerve is severed, the various lines and connections can be reconnected through a surgical procedure. However, it is not as simple as it sounds, particularly when speaking about the nerves of the hand, which are thin strands no bigger than threads of yarn.

The good news is that it can be done, but it does have a lengthy recovery process. The initial goal is to get that outer sheath back together in order to encourage the inner nerves to reconnect and restore themselves. This is why any surgeries for nerve injuries demand at least three weeks of “downtime” after the procedure. Even then, the pace of regrowth is very slow, and to prevent any further damage, the patient is discouraged from using the digit or hand during the initial recovery period.

After that, however, there will be the need to use therapy to help the hand or fingers regain flexibility and function.

Your hand surgeon can review the options for nerve repair, and let you know your expected prognosis. With time and work, though, even severed nerves can be recovered or restored to at least partial function and health.

Source

ASSH.org. Nerve Injury. 2015. http://handcare.assh.org/SearchResults/tabid/145/SearchModuleID/1720/sites/1/Default.aspx?SearchTerm=damaged+nerves

Categories
General Hands

Hand Numbness and Tingling Is Not Always Carpal Tunnel

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There has been so much press about the condition known as carpal tunnel syndrome, or CTS, that many people automatically assume that any numbness or tingling in their hands or fingers must be this fairly common condition. However, there are several other issues that can just as easily lead to symptoms shared with CTS.

For example, the American Society for Surgery of the Hand indicates that the “potential conditions” leading to numbness in the hands include: vascular disorders, cold hand disease, Erbs palsy, CTS, Complex Regional Pain Syndrome, nerve injury, and cubital tunnel syndrome.

Are these the only reasons behind numbness and tingling in the hands or arms? No, there is a surprisingly long list of possibilities. Injury can be to blame, muscle thickening, blood vessel enlargement, and cysts and spurs can also be the cause of any loss of sensation or tingling.

However, one of the most common terms associated with the sensation of tingling or loss of feeling in the hands, though, is “nerves”. From compression of nerves in the arms, spine, and neck, to damage to the nerves, it seems that the greatest number of problems can begin with nerve related issues.

Compression neuropathy or pressure on a nerve can cause a sensation of numbness in the hands. Additionally, because some nerves in the hands have their sources in the area around the neck, any sort of compression or pressure on the neck can lead to numbness, as well.

When we start to look at the neck, though, we realize that the spine is also a major factor in nerves and how they affect the hands. Arthritis in the neck or spine, as an example, can be compressed due to bone spurs or disc problems, and these might impair nerves that relate to the hands and arms.

Diseases of the spinal cord can also cause problems if they manifest as tumors, swollen blood vessels or other things that can constrict or press on the nerves. These can lead to weakened muscles if compressed as well, and this can further complicate matters by making the source of the problem more difficult to detect.

Not all nerve activity is in the spine though and it is understood that some diseases that affect the nervous system can lead to symptoms that include numbness in the hands. Multiple sclerosis is a key example of this, but other issues may also present in this way. Peripheral neuropathy is yet another nerve-related issue that can be caused by disease and which presents in a glove-like pattern on the hands and arms. Diabetes is a common cause of this sort of hand numbness or tingling.

You may have numbness in a finger after an injury, and some medication and treatments can also have side effects that include numbness and tingling in the hands.

Diagnosis and Treatment of Hand Numbness and Tingling

Clearly, you must never just guess at what is causing you tingling or numbness in your hands, and you should never ignore it. Instead, the wisest course of action is to visit a physician or hand doctor who can take a full history, do an assessment of your condition and help you overcome whatever issue has led to your discomfort.

Categories
General

Osteoarthritis and Your Hands

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Arthritis appears in many different variations. Some types of arthritis can show up in any region of the body, some strike single joints are locations, and some appear only when a joint or limb has been damaged or injured. One of the most common types of arthritis is the variety known as osteoarthritis, and when it appears in the hands it usually does so in a limited number of places.

The most common spots for osteoarthritis to appear in your hands are the end joints closes to the tip of the finger (technically known as the DIP joint); the base of the thumb where it meets the wrist (known officially as the trapezio-metacarpal or basilar joints); and the joint in the middle of a finger (called the PIP joint).

Though it may show up in other areas, including the wrist, it is most likely to develop in the spots listed.

It is not like rheumatoid arthritis that attacks the synovium, but is instead a “wear and tear” type of arthritis that causes inflammation due to the loss of the cartilage between the different joints. In osteoarthritis, which is known as a degenerative condition, the pads of cartilage between bones wear down or are damaged and then begin to degrade. This leaves your bones actually rubbing against one another, and it can cause a long list of symptoms.

The Signs of Osteoarthritis

Obviously, the most common symptom associated with two bones rubbing together is pain, but many people with osteoarthritis in the hands will experience stiffness, an inability to flex or move the affected joint, tenderness in the joint, bone spurs, and an obvious sense of the two bones grating against one another (MayoClinic.org, 2015).

Bone spurs or bony nodules are very noticeable when you have osteoarthritis of the hands, and you will notice the unnatural swelling at the joints most commonly affected. The sense of pain is often described as aching, but many also complain of a loss in the ability to grip tightly or have much strength in the hands too.

Treating the Condition

As in other arthritis treatments, the focus of the treatment of osteoarthritis in the hands is to alleviate pain when present while also restoring or maintaining function. To do this requires a few different tactics, and it is only after a visit to your hand doctor that a full and proper regimen can be developed.

You may be given anti-inflammatory medications and instructed to use rest whenever any swelling occurs. Further modalities might include the use of heat and hot wax treatments, splints, and other therapies. It is also not unusual for steroid injections to be relied upon to help with movement and swelling. The only reason that a doctor may suggest surgery is when pain is not alleviated through more conservative treatments or when movement and function have been lost.

Osteoarthritis is not something you can easily avoid, but it is treatable. A visit to your hand doctor at the first signs of stiffness or swelling can put you on the track to protection of the joints and treatments that protect your hands function.

Source

MayoClinic.org. Osteoarthritis Symptoms. 2015. http://www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/symptoms/con-20014749

Categories
Conditions General

Understanding Reflex Sympathetic Dystrophy and Your Hands

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The word “misfire” is an appropriate term to use when discussing reflex sympathetic dystrophy or RSD. This is a condition in which the nerves send inaccurate signals to the brain, and create what many describe as an abnormally high pain response to a minor or even non-existent issue. For example, it is not unusual for someone with RSD to get a paper cut or small injury to a finger and feel a tremendous amount of pain or discomfort from such a minor issue.

So, just why does this happen? The disproportionate pain of RSD is due to some sort of malfunction in the nerves following an actual injury, surgery, or trauma. What experts believe is that injury or damage to a nerve may have been sustained and this provokes the future overreactions and hyper responses to any pain stimulus in the future. Experts tend to break RSD into to “types” – the kind after an injury, which should not have affected the nerve and an actual injury to a nerve (AAOS.org, 2015).

Indicators of RSD

Knowing that RSD can result from actual nerve damage or following an injury is helpful in recognizing it when it appears. Additionally, knowing that the experience of pain is far out of proportion with the incident is another useful indicator for diagnosing the condition.

Many with RSD also describe pain as constant or burning when an injury occurs, and generally lasting much longer than what one would expect from the specific injury received. When it occurs in the hands, it comes with a set of additional characteristics that help to make the diagnosis.

For one, the extremity is often swollen and quite warm to the touch. There may be pronounced perspiration and a shiny appearance to the skin, and hands with RSD may also be immobile or limited in their range of motion.

Unfortunately, the symptoms of RSD can vary quite widely from one person to the next, and so it is impossible to draw a conclusion without a more in-depth analysis by a hand doctor. One thing that does seem to apply to all cases is that the earlier the treatment can begin, the better the outcome. Anyone concerned that they are experiencing disproportionate pain in their hands after an injury should, therefore, head to the physician as soon as possible.

They will explore the patients history while also using diagnostic tools such as bone scans, thermography, and X-rays.

Treating RSD

Once it is confirmed that RSD is indeed an issue, there are a few ways it can be treated. The primary goal is to reduce or eliminate pain. This can be done in several ways that include medications such as topical pain relievers, steroids, and others. There is also basic therapy that can restore function and reduce pain. There is a process that is used to numb the stellate ganglion, which is a group of sympathetic nerves. This allows therapy to be more effective by eliminating pain temporarily while treatment is done. There is also psychotherapy as well as surgery.

It is impossible for a hand doctor to predict the outcome of any treatment, but all agree that it is a “sooner the better” sort of issue. So if you feel you have RSD or suspect a loved one has developed it, get to your hand doctor immediately.

Source

AAOS.org. Complex Regional Pain Syndrome. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=a00021

Categories
General

What Can Be Done About Scaphoid Non-Union Injuries – Arora Hand Surgery

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Your hands and wrists contain a lot of bones, and in the wrist alone are eight individual bones. Set in two rows, they are linked by one bone known as the scaphoid. Unfortunately, due to its position and the role that it plays in the hand and wrist, it is the most commonly fractured bone in the hand. Even worse is that a fracture of this bone is not always easy to diagnose, and some people are unaware of the severity of an injury to their hand for days or even weeks afterward.

This is particularly troublesome because the location of the bone already makes it challenging to heal. It is well known that the blood supply to the scaphoid is fragile even before any breaks may occur, and afterward it may be completely impaired. This can make it almost impossible for it to heal, and when this happens it is known as a non-union injury.

And though it is a tiny bone, the scaphoid non-union can lead to diminished or lost movement of the wrist and even to arthritis.

Diagnosis and Treatment

A fractured scaphoid is often due to a fall, and though it might hurt initially, it often seems to get better quickly, and this is why diagnosis can be tricky. As the American Association of Orthopedic Surgeons explains, “A scaphoid fracture is usually caused by a fall on an outstretched hand, with the weight landing on the palm.” (AAOS.org, 2015)

Thus, you may think you have merely sprained the wrist, and once the discomfort ends you may forget the incident, even though movement of the wrist now seems limited. This is why no falls of this kind, and no hard blows to the wrist can be ignored or overlooked.

A visit to the hand doctor is the only way to determine if a fracture has occurred, and if it is of the difficult non-union variety. In fact, you may find yourself getting in touch with them soon afterward because the non-union fractures so often follow a very common pattern. The wrist begins to lose range of motion, stiffness sets in, and even arthritis symptoms may start to appear because of the persistent inflammation to the tissue.

If your case is not advanced, you may be able to have the most conservative treatments such as therapy or surgery to align the bones and trigger healing. However, you may also need the use of surgical pin or bone grafts if the absence of blood has caused bone death.

In advanced cases, surgery is still an option but it will be to help manage pain and preserve what movement remains. It is always a case of “the sooner the better” in such cases. So, if you have recently taken a fall that may have harmed the scaphoid bone in your wrist, or you feel that an old injury is causing problems, dont hesitate to phone your hand doctor for a thorough exam and discussion of your options.

Source

AAOS.org. Scaphoid Fracture of the Wrist. 2015. http://orthoinfo.aaos.org/topic.cfm?topic=A00012

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Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

L B.