David Nelson Hand Surgery Greenbrae Marin hand specialist surgery of the hand orthopedics San Francisco

 

 


New Patient's Information

 


The types of conditions treated

Dr. Nelson is an orthopedic hand surgeon. He treats almost all aspects of the arm, from the fingertips to the mid forearm (as well as some elbow problems), from bones to tendons, from muscles to nerves.

Dr. Nelson is Board-Certified in Orthopedic Surgery and in Hand Surgery. You can see his resume here.  If you would like help in deciding if Dr. Nelson is the right physician for you, read these suggestions on choosing a doctor. Our office hours and a map to our office are also online.

Dr. Nelson is a firm believer in the role of the physician as an educator. We don't do things to you, we do them for and with you. Patient education is an important part of our practice. Click here for an index of patient education topics.

Dr. Nelson has designed four orthopedic implants or products, including a suture anchor, distal radius external fixator, distal radius internal fixation plate, and an instrument for assisting in the surgery of broken femurs (thigh bone). He receives royalties from these as well as from lecturing nationally and internationally. This disclosure is made to satisfy the disclosure requirements of the American Academy of Orthopedic Surgery.

When should I have my first appointment?

You should have been instructed by your referring physician concerning how urgent your problem is and when you should be seen. The section below is for general guidance; it cannot substitute for the judgement of your referring physician. The referring physician should have said call right away for an appointment. It is unlikely that they said that you had to be seen right away. If in doubt, ask the referring physician.

We do not over book appointments, so you need to call right away to schedule your appointment. You don't want to be rushed through your appointment, so please be understanding if we do not over book you into the day that you want and make us rush another patient through their visit.

In general, sprains need to be rested, iced, and elevated for about a week to allow the swelling to go down and to allow Dr. Nelson a better chance to examine your hand. If it is too swollen and hurts everywhere, the exam is not as informative as when the generalized swelling and pain have decreased. Sprains, in general, should be seen about a week to 10 days after the injury, unless a problem develops (e.g., numbness that was not present initially). New onset numbness is potentially a severe problem, and you should contact your referring physician or this office immediately.

In general, dislocations need to be started on early motion, to prevent stiffness. This is particularly true of the PIP joint (see Anatomy for the names of the joints.) Your dislocation should have been reduced in the Emergency Room, as these are an emergency until relocated; after they are relocated, they are no longer an emergency. You should be seen in about a week to two weeks. The joint needs some time to recover prior to being seen by Dr. Nelson. In general, you should be taken out of the splint and started on gentle range of motion within two to three days, especially for the PIP joint. Ice and elevation are important. Consult your treating physician on all of these issues, as dislocations are too complex an issue to be decided by reading a website. If you had xrays taken, you need to bring them in with you. For directions on picking up xrays, click here.

In general, fractures should be seen within a few days, so that Dr. Nelson can review the xrays and suggest what your treatment options are. The Emergency Room physician cannot make that determination in all cases. See Dr. Nelson's Fractures Page. New onset numbness is potentially a severe problem, and you should contact your referring physician or this office immediately. Be sure to bring your xrays in with you for your first visit. The Emergency Room cannot arrange for the films to be delivered, and Dr. Nelson needs the xrays when he first sees you in order to be able to determine the exact nature of your injury and to explain the xrays to you. For directions on picking up xrays, click here.

In general, lacerations should be seen at about a week to 10 days, unless there is a question of infection. If you are not sure, contact the physician who referred you and determine when you need to be seen.

In general, fingertip crush injuries should be seen in about 2 weeks, if it has been repaired (sutured). We do not want to disturb the healing by removing the dressing. If the injury has not been repaired, you should have been told to call right away for an immediate appointment. The referring physician should have already discussed your case with me. If not, there may be a problem. Call right away. See the Fingertip Crush Page. Numbness is normal with a fingertip crush, so don't worry. If you had xrays taken, you need to bring them in with you. For directions on picking up xrays, click here.

If you are being referred for an injection (typically for trigger finger, carpal tunnel, ganglions), this it typically not an urgent matter. Read the section of this website on your problem, and read the page on injections.

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What to do for your condition before you see the Dr. Nelson

Sprains

In general, sprains need to be rested, iced, and elevated for about a week to allow the swelling to go down and to allow Dr. Nelson a better chance to examine your hand. If it is too swollen and hurts everywhere, the exam is not as informative as when the generalized swelling and pain have decreased. Sprains, in general, should be seen about a week to 10 days after the injury, unless a problem develops (e.g., numbness that was not present initially). New onset numbness is potentially a severe problem, and you should contact your referring physician or this office immediately.

 

Dislocations

In general, dislocations need to be started on early motion, to prevent stiffness. This is particularly true of the PIP joint (see Anatomy for the names of the joints.) Your dislocation should have been reduced in the Emergency Room, as these are an emergency until relocated; after they are relocated, they are no longer an emergency. You should be seen in about a week to two weeks. The joint needs some time to recover prior to being seen by Dr. Nelson. In general, you should be taken out of the splint and started on gentle range of motion within two to three days, especially for the PIP joint. Ice and elevation are important. Consult your treating physician on all of these issues, as dislocations are too complex an issue to be decided by reading a website. If you had xrays taken, you need to bring them in with you. For directions on picking up xrays, click here.

 

Fractures

In general, fractures should be seen within a few days, so that Dr. Nelson can review the xrays and suggest what your treatment options are. The Emergency Room physician cannot make that determination in all cases. See Dr. Nelson's Fractures Page. New onset numbness is potentially a severe problem, and you should contact your referring physician or this office immediately. Be sure to bring your xrays in with you for your first visit. The Emergency Room cannot arrange for the films to be delivered, and Dr. Nelson needs the xrays when he first sees you in order to be able to determine the exact nature of your injury and to explain the xrays to you. For directions on picking up xrays, click here.

 

Lacerations

In general, lacerations should be seen at about a week to 10 days, unless there is a question of infection. If you are not sure, contact the physician who referred you and determine when you need to be seen.

 

Fingertip Crush Injuries

In general, fingertip crush injuries should be seen in about 2 weeks, if it has been repaired (sutured). We do not want to disturb the healing by removing the dressing. If the injury has not been repaired, you should have been told to call right away for an immediate appointment. The referring physician should have already discussed your case with me. If not, there may be a problem. Call right away. See the Fingertip Crush Page. Numbness is normal with a fingertip crush, so don't worry. If you had xrays taken, you need to bring them in with you. For directions on picking up xrays, click here.

 

Injections

If you are being referred for an injection (typically for trigger finger, carpal tunnel, ganglions), this it typically not an urgent matter. Read the section of this website on your problem, and read the page on injections.

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What should I bring to my first appointment?

Be sure to bring:


1)   The report from your referring physician, unless you are being referred from the Emergency Room (if you don't bring it, I will not know what your referring physician was thinking.)

2)   The xrays, if any were taken (if you were seen at the Marin General Hospital, call 925-7300 and obtain your xrays). For directions on picking up xrays, click here.

3)  Your insurance information; please determine if you have a co-pay and how much it is. If you do not know, contact your insurance plan. Please try to have the correct amount for the co-pay, as we have a limited amount of change. We accept Visa and Mastercard, but you need to have the card with you at the time of the appointment. We cannot accept charge cards over the telephone. A check is OK, too.

4)  Here are forms you can download, fill out, and bring with you. It will save you time in the office.

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Payment

Payment is expected at the time of the visit. Please know your policy. If you need to, call your insurance company to find out about co-pays, coverage, etc Your insurance is a contract between you and your insurance company, and even if I am a provider for that insurance company, my office will not know the details of your contract. For instance, Blue Cross may be one company, but in California they may have thousands of different versions of their insurance policy, and my office cannot know all of the details. If your policy requires you to pay a co-pay, please bring it with you, as we are required by insurances with a co-pay to collect the co-pay at the time of the visit (they use this co-pay as a way of limiting your access to healthcare). We accept check, cash, and Visa and Master card.

If you do not have insurance, have insurance with an HMO, or have insurance with a company that we do not contract with (probably because they either do not pay the doctor enough to be able to provide excellent care or have mechanisms to limit the options I have in treating you), if you do not have a credit card, we can make arrangements for a payment plan so that we can still provide you with care. Please discuss this with the secretary prior to your appointment. We will work something out so that we can see you. If you cannot work something out with the secretary that is satisfactory to you, please ask to speak to me directly. We are here to serve you, and will not vary from that standard. Hopefully, that is the feeling you have gotten from reading my website.

Remember the admonition from the Patient Education Links Page: the Internet has a lot of information, much of it incorrect. I have reviewed the sites that I have linked to, and have only linked to sites when I personally know the surgeon who posted it, or am a member of the organization that posted it. However, I may not agree with all that is on that site, and it may have changed since I reviewed it. If any of the information is not consistent with what I have told you, please download the material and bring it in.

I look forward to seeing you! ~ Dr. Nelson