What is Carpal Tunnel Syndrome?
The median nerve runs through the arm and forearm into the hand and controls feeling in the thumb and index, middle, and ring fingers. Carpal Tunnel Syndrome (CTS) occurs when this nerve gets compressed as it passes through the wrist, leading to symptoms that include weakness, numbness, tingling, and pain in the hand and first three fingers. The often debilitating condition is the most common workplace injury, affecting an estimated 13 million Americans.
How is Carpal Tunnel Syndrome Treated?
Patients with mild CTS symptoms may experience some relief by wearing a wrist splint, getting steroid injections, and avoiding activities that exacerbate the condition, but many cases will require surgical intervention to relieve the pressure on the median nerve. Traditionally, patients had two options: open, or mini-open, carpal tunnel release surgery, and endoscopic surgery. Open surgery, while effective, is an invasive procedure that can leave painful scars and require long recovery times. Endoscopic procedures are less invasive, but can be complicated by limited visualization.
What can I expect if I have Ultrasound Guided Carpal Tunnel Release?
Many patients delay carpal tunnel surgery because of concerns about having an invasive surgery and worry about the recovery time and being able to get back to work. Ultrasound Guided Carpal Tunnel Release is a minimally invasive procedure performed using local anesthesia and requiring a very small incision typically closed with just a bandage. The ultrasound guidance gives the surgeon a clear view of the carpal tunnel, allowing for greater precision and minimizing the risk of complications. Most patients don’t need post-operative physical therapy and return to normal activities within 3-6 days. Our hand and wrist specialist Dr. Quitkin is the 4th surgeon in New Hampshire, and the only one in the Portsmouth region, to offer Carpal Tunnel Release with Real-time Ultrasound Guidance.
We sat down for a Q&A with Atlantic Orthopaedics’ Hand & Wrist specialist Dr. Quitkin to learn more about this procedure.
Q: How does this procedure benefit your patients?
A: Carpal tunnel syndrome is the most common peripheral nerve compression syndrome. It affects millions of people, with hundreds of thousands of new cases developing annually. In some cases, symptoms can be managed conservatively with splinting and activity modification. For patients whose symptoms cannot be adequately controlled with non-surgical treatment, carpal tunnel release offers lasting relief of symptoms. The standard mini-open carpal tunnel release, which I have done for more than 20 years, is an excellent operation that solves the problem of carpal tunnel syndrome. It’s only drawback is the palmar incision through which the procedure is performed. This incision leaves a scar in the palm that is initially firm and tender. While the scar eventually softens and the discomfort associated with it recedes, the scar symptoms may take weeks to as long as months to completely resolve. Carpal tunnel release with ultrasound guidance allows us to move the incision from the palm, where the tissue is thick and prone to developing stiff, tender scars, to the distal forearm, where the tissue is much thinner and more pliable. Scars in this area tend to heal very quickly and are minimally symptomatic. This effectively solves the only problem with the mini-open carpal tunnel release. The improvement in the carpal tunnel symptoms is the same, and the recovery is faster and less painful.
Q: Who is a good candidate for the procedure?
A: Most people are good candidates for the procedure. Prior to surgery, patients are evaluated with an ultrasound examination in the office to be certain they are good candidates for the procedure. The only contraindications are significant anatomic variations within the carpal canal or inability to adequately visualize the carpal tunnel under ultrasound.
Q: Where can a patient have this procedure performed?
A: Currently, carpal tunnel release with ultrasound guidance is being performed at NECOS. And, we are awaiting approval to begin doing cases at York Hospital as well.
Q: Tell us about a success story!
A: For most of my career, I have declined to do bilateral carpal tunnel releases on the same day, because the timing of palmar scar healing was sufficiently unpredictable that tying up both hands simultaneously could put patients in a very difficult position. With the ultrasound-guided technique, the recovery is sufficiently predictable and sufficiently quick that releasing both carpal tunnels on the same day is now feasible. Recently, a woman in her forties was having disruptive carpal tunnel syndrome symptoms in both hands. She has a seasonal job, and was very concerned about missing time during her busy season. With the ultrasound-guided technique, we were able to treat both hands on the same day and have her symptom-free for the start of her season a couple of weeks later!
Q: Is there anything else you’d like patients to know?
A: The use of ultrasound-guidance solves the only problem with an otherwise great procedure. This is a big step forward in hand surgery.
Carpal tunnel release with ultrasound guidance is a safe, effective, minimally invasive alternative to traditional CTR surgery. Its advantages include real-time visualization during the procedure, lower risk of complications, and shorter recovery time. If you’re experiencing symptoms of carpal tunnel, schedule an appointment to find out if carpal tunnel release with ultrasound guidance is right for you, so you can get back to doing what you love.