Endoscopic Carpal Tunnel Treatment

Untreated Carpal Tunnel Syndrome

Untreated Carpal Tunnel Syndrome (Photo credit: Wikipedia)

This is a transcript of a Dr. Jay Show broadcast on 1560TheGame. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Richmond and Sugar Land, TX. Call 281-633-8600 for an appointment.

Here’s the transcript of the second portion of the Show:

Bennett:  Anyway, so we’re here with Dr. Alan Rodgers talking about hand pain and hand injuries.  I want to do a shout out to the Texas Sports Medicine Institute for sponsoring us out here today, check out the website –  www.texassportsmed.com . We’re actually going to go with our first caller.  We’ve got Tim.  What’s going on, Tim?  

Caller:  I’ve seen a lot of advertising about the endoscopic carpal tunnel procedures, and my question is, how is that different from the common way they do the procedures, and is it actually more beneficial in surgery than the others?  

Bennett:  That’s a great question, Tim, we appreciate you calling in and listening to the show.  The endoscopic carpal tunnel release is something you’re going to see a lot of marketing on, and when I talk about this show, the big thing for us is to help you sift through all the smokescreens and the mass marketing that is out there.  If you see a lot of TV ads and all of that on the endoscopic release, they make it sound like they’re the only people on the planet that do it.  But let me assure you that it is a very common procedure and a lot of doctors do the endoscopic carpal tunnel release and you can probably get it done and have it fully covered by your insurance as opposed to going to one of these facilities where they claim that they are the only ones that do it.  I do endoscopic release as well as Dr. Rodgers.  Dr. Rodgers can tell you a little bit more about his technique and the way that he likes to do it and the benefits of doing the endoscopic release over doing the open release.  

Rodgers:  The endoscopic release is one of our most popular procedures.  A lot of people have carpal tunnel syndrome which is usually characterized by numbness, tingling in the fingers, the hand feels like it’s going to sleep, even weakness in later stages.  And it is a very treatable condition that often unfortunately gets neglected because people don’t know to seek help for that at an early stage.  The endoscopic procedure takes about 20 to 30 minutes and is done under anesthesia, but you go home the same day, have only a soft dressing on your hand, the stitches dissolve and you are usually back to using that hand that afternoon.  There’s of course no heavy lifting for a couple of weeks, but then you’re back to full use of the hand within a month. So it really isn’t something that’s going to take you out of commission. Now if you do have an occupation that requires heavy lifting, you might have to take some time off. But for the most part people take very little time, if just the day of the surgery of maybe the day after, and they’re back to doing 90 percent of their job right away. 

Bennett:  I think it’s a very popular procedure and I think it’s actually a very good procedure.  The old way we used to do it was an open procedure in the mid-palm of the hand and there are still some indications to do it that way if needed and there are still a lot of doctors that do it in that fashion. Nothing’s wrong with it but if you do want to have a small, single incision and a minimally invasive procedure, I think it is a very good option and it is a safe option as long as you go to a physician that is trained in this and has experience doing the procedure. One thing I noticed in patients that come to me that have carpal tunnel syndrome, the numbness and tingling that Dr. Rodgers mentioned can sometimes be a positional issue, affected by the way that people sleep at night, the way they bend their hands – I call it the “Praying Mantis Position” where they actually flex their hands and get numbness at night.  We start off by giving them an anti-inflammatory and maybe some night splints.  If they keep

A rigid splint can keep the wrist straight.

A rigid splint can keep the wrist straight. (Photo credit: Wikipedia)

on having problems, we get a nerve test which is called an EMG, which actually confirms that they have carpal tunnel.  Now if you have a patient that has carpal tunnel, can you explain what happens to these patients that say, “I don’t want to have it fixed right now, I’d rather just wait and see what happens.”  If their nerve test says they’ve got severe carpal tunnel syndrome, what do you tell them in regards to the prognosis if they do not get treatment done immediately?

Rodgers:  No one really wants to go in and have surgery immediately, but when a nerve test shows severe compression, you’re really at risk for permanent nerve damage.  And what happens when a nerve is compressed is it’s not getting the circulation, it’s damaging and destroying the fibers – the nerve fiber is millions and millions of small, microscopic nerve fibers – and the more you compress, the more fibers can be killed and once those nerve fibers are permanently dead, they do not regenerate. Unfortunately our bodies do not regenerate the nerve cells so what we’re trying to do is protect the nerve fibers that you have remaining and to make sure that no other ones get compressed to the point where there is no return.  So it’s one of the things that waiting, especially when you have a severe condition, is not recommended. Now if you don’t have a severe condition there are things that we can do, from steroid injections and splinting, as Dr. Bennett mentioned, to even physical therapy for some mild cases. But when a nerve study shows a severe condition, I generally strongly recommend surgery and I think it’s my job to educate someone if they don’t have surgery, what the possible consequences are, which could be permanent weakness and numbness of the hand.

Bennett:  I think it really is a kind of prevention procedure because I think that if you have a patient that has severe carpal tunnel syndrome like you mentioned, even doing the release, they may already have that nerve damage that’s occurring at least partially, and sometimes doing the release may not get rid of the numbness because that damage is already there but it prevents them from getting to the point where they can’t use their hand and they drop objects and the hand actually becomes atrophic or weak and it actually gets worse.   It’s more of a measure to prevent it from progressing and getting worse and I think it’s a great option.  So if you have this numbness and tingling and hand pain, then I would suggest you get evaluated by a specialist or an orthopedic surgeon that does these kinds of procedures so you can get the appropriate work-up so at least you know what you’re dealing with and what to expect.  I think that that’s something to definitely look at.  Dr. Rodgers, if people want to get in touch with you, I believe your website is:  www.theartisancenter.com , and your number is 281-578-7600, correct? 

Rodgers:  That is correct. 

If you have questions about carpal tunnel syndrome or if you’re experiencing tingling or numbness in your fingers, please call our office at 281-633-8600 for an appointment.

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