Carpal Tunnel Fix Easier With Endoscopic Approach
e-mail: Mary Muhlbradt
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Carpal tunnel syndrome causes pain, numbness, and tingling in the hand and arm. It's also an important cause of work disability. The good news is that now there's less reason than ever to put up with the pain and discomfort, thanks to a surgical fix that is minimally invasive, called endoscopic carpal tunnel surgery.
Hand surgeon Daniel Williams, MD, joined Trinity Health last fall after completing a hand surgery fellowship and receiving additional training in small-incision, minimally invasive techniques that reduce the impact of surgery and hasten recovery.
"In the few months I've been here we've helped numerous patients with carpal tunnel syndrome," Dr. Williams said. "I don't think a week has gone by when we haven't scheduled several cases. They've included patients ranging in age from 21 to 97 years."
Carpal tunnel syndrome occurs when the tissues surrounding the tendons in the wrist swell and put pressure on the median nerve. The goal of carpal tunnel surgery is to release the ligament that surrounds the crowded structures, much like a tightened noose.
In an open, conventional surgery the surgeon makes a 4 inch incision from the wrist to the middle of the palm, cutting through the skin and fascia (connective tissue surrounding the muscle) to get to the ligament. This involves quite a lot of pain due to the large incision and sensitivity of the palm.
"With the endoscopic approach we can accomplish the same goal by making a small,
3/4 inch incision across the wrist," Dr. Williams explains. Through this incision we insert a very small instrument connected to a fiber optic camera and slip it under the skin and tissue to release the carpal tunnel compression. With this approach there's less trauma involved. Patients really notice the difference."
The procedure, which is performed under local anesthesia with light sedation, takes only about 10 minutes. Total time in the surgery suite is under an hour. And patient outcomes have been very good, Dr. Williams reports.
"People can use their hands immediately after surgery," he notes. "Most patients go back to work the next day unless they have very strenuous jobs; then it may take 2 to 3 days. The small-incision procedure involves the same long-term risks and benefits as an open surgery, but with less pain and quicker return to daily activities. That's why I prefer to do it."
Dr. Williams is quick to add that surgery is seldom the first option, however. "There are conservative remedies we can try, such as splinting or, in some cases, steroid injections. But if they aren't successful and people get fed up with the pain and discomfort, it's nice to have this small-incision procedure to offer patients."
A graduate of Meharry Medical College in Nashville, TN, Dr. Williams completed his General Surgery residency at Howard University Hospital, Washington, D.C., where he served as chief resident. He completed a hand surgery fellowship at the University of Mississippi Medical Center, Jackson, MS, and received additional training in minimally invasive surgical techniques. He is a member of the American Society for Surgery of the Hand.
- No incisions on the palm, which is very sensitive to pain
- 3/4 inch wrist incision, compared to 4 inch palmar incision
- Return to work, daily activities faster
- Less pain and weakness in the hand after surgery
- No sutures needed (sutureless surgery in most cases)
- No splints or cast
- Light dressing applied to the hand for first 72 hours
- Patients can use hand and wrist immediately after surgery
- Majority of patients return to work next day or 2-3 days for very strenuous jobs
- Significant resolution of symptoms within first 24-48 hours, depending on severity of pre-operative symptoms
- One post-op visit a week after surgery for wound check
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