SALT LAKE CITY — The hand and wrist have dozens of bones, not to mention tendons and muscle and nerves and blood vessels, to name some of the components.

All that, combined with close quarters, makes it an exceptionally complex region when things go wrong. And sometimes fixing one problem doesn't mean there aren't others that must be dealt with, too.

"You could have carpal tunnel, a trigger finger and arthritis at the same time," Dr. Michael Raemisch told a caller to Saturday's Deseret News/Intermountain Healthcare Health Hotline. He's an orthopedic surgeon specialising in hand and upper extremity repair.

He and colleague Dr. James Gardiner, an orthopedic surgeon who treats shoulders, took more than 50 calls and answered questions posted on the Deseret News Facebook page, as well, during the sometimes-hectic hotline. The calls ranged from wrist repair to carpal tunnel and rotator cuff injuries. Both doctors practice at the LDS Hospital Joint Center.

Several callers asked about trigger finger, which is an irritation of the finger or thumb tendon, which causes it to have a hard time sliding in and out of the finger, making it catch.

One woman complained about arthritis at the tip of her shoulder, which Gardiner assured her is a pretty good location to clean up surgically. When the arthritis is down inside the joint, a shoulder replacement may be needed.

Especially in younger patients, surgeons try to put off full shoulder replacement as long as possible; they are not quite as durable as artificial hips and knees. After years of an active life post-surgery, the joint can wear out and need to be replaced, he said.

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A couple of callers said they have been diagnosed with calcium tendonitis and wondered about treatment. The condition, which includes a calcified deposit in the shoulder that irritates the tendon, can be severely painful, he noted. But it often responds to a steroid injection to decrease inflammation and pain. Sometimes, that may be the only treatment needed. In other cases, using a needle while guided by ultrasound image, the doctor may be able to suck the calcification out with the needle, right in the doctor's office. Sometimes it's chalklike. But when it's the consistency of toothpaste it can be drawn out.

Most shoulder surgeries, such as rotator cuff repairs or dislocation repair, Gardiner said, can be done arthroscopically. That's not possible, though, for a break near the top of the humerus or a shoulder replacement.

The hotline tackles a different health-related topic on the second Saturday or each month.

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