Faster Carpal Tunnel Recovery with Vanishing Incisions
Why does ECTR cause so much less discomfort and appeal so much more to patients than open release or "filet of Wrist?"
With endoscopic carpal tunnel relief only the tight transverse carpal ligament and the palmar aponeurosis that compress the median nerve are released. The two tiny incisions are each only 3/8" and are displaced away from the wrist itself. The subcutaneous (layer just below the surface) nerve fibers are thus not injured. There is less injury to heal and less visible bruising and local discomfort with less effect on grip and pinch strength. This yields an absolute and psychologically superior, immediate outcome. Also after 6 months it's nearly impossible to detect a scar compared to the obvious scar from an open filet-of-wrist carpal tunnel release.
How can a laser assist the surgeon and does it actually benefit me or is laser just a gimmick?
Good question. Laser is just a hot knife preventing any local bleeding when it comes to surgery. The units available for us are a bit cumbersome and their use requires a lot of extra expense. I was part of a hand surgeon's focus group on this issue. The consensus is that little would be gained. The only case of laser use for ECTR that I am aware of resulted in a severe complication-see Bibliography.
I'm the breadwinner and I work using both of my hands all day long. I have CTS in both hands. How much time will I be "laid up" after endoscopic carpal tunnel release?
Since 1992 I have set the return to work record internationally to which other surgeons aspire. Initially it took a week to get the most stubborn patients to use their hands fully. Then I started getting people back to work the Monday following a Friday surgery. In 2006 I pioneered return to work without even clocking out for office workers! In 2007 I extended this to some factory workers with a progressive safety manager at Tenneco. Most of my patients are able to return to at least modified duties the day of or after surgery progressing to unrestricted activity within one to two weeks. The only absolute restriction relates to the need to keep the incisions clean to prevent infection. My carefully crafted protocol using select medication and special exercise without formal physical therapy or braces has proven very successful. As can be seen in the section on "Best Solution" the best other hand specialists have been able to do elsewhere is about 2 weeks time off. So you see, there is no good reason to procrastinate.
Since I golf almost every day, weather permitting, what effect will Endoscopic Carpal Tunnel Release have on my ability to play?
First, you will probably no longer fear your driver or irons flying out of your hands. Second, you will probably be able to resume at least putting the day following surgery. Within a week of surgery you should be able to use your irons and driver. It is essential to keep your operated hand clean for a week. Picking up dirty golf balls might be a source of wound contamination and could result in infection.
Is ECTR definitive or do I have to worry about recurrence?
That is a very common and important question. Unlike placebos and quackery like magnets, copper bracelets, cortisone injections and "carpal tunnel exercises" for about 98%-99% of patients undergoing surgical release the result is permanent. In fact, after undergoing endoscopic carpal tunnel release a person has less chance of getting carpal tunnel syndrome back than a non-operated person has of developing the problem i.e. about a one in six chance. Most people who think that they have failed carpal tunnel surgery or recurrent CTS actually have untreated cubital tunnel syndrome (see associated ailments).
Can I have my cubital tunnel (ulnar nerve at the elbow) treated at the same operative time as my carpal tunnel?
Absolutely, and now you can have an endoscopically-assisted cubital tunnel decompression. This minimally invasive technique hurts less with less bruising. It requires only about a one inch incision. No restrictions are added so all you have to focus on is keeping your incisions clean.
Why can't I ever spend time with my doctor but instead a have to see his physician's assistant (PA)? I have heard that you spend a lot of time with your patients going over every detail.
It's probably a matter of economics. Insurers are not reimbursing specialists adequately yet specialists have a high overhead. This is unfortunate. I am results-driven and therefore I won't compromise. Most of my colleagues are not as efficient. Whether or not it says anything about insufficient dedication I don't know. You have a right to see the physician. You and others need to be vocal to your insurer about reimbursing at a level to allow survival. Contrary to propaganda we medical professionals can rarely raise our rates and reimbursement has only drifted downwards not upwards for the past 20 years.
What is percutaneous trigger finger release and what is the advantage over traditional open release?
Trigger Finger Before Treatment
Trigger Finger Surgical Procedure
Percutaneous A-1 pulley release (trigger finger or thumb release) is the least invasive and the least uncomfortable and therefore the best treatment for chronic trigger finger or trigger thumb. The open technique requires a trip to the operating room. The hand is painful for weeks and both the soreness and the need to keep the wound clean slow a person down. I have been using a needle technique since 1997. Patients are evaluated and completely treated in a single office visit. Most patients require no medication for discomfort. The only stipulation is that the patient's finger or thumb has to be actively snapping in order to apply this technique. This usually means a morning appointment since obvious triggering predominates in the morning. I do not offer this technique for infants and toddlers for congenital trigger thumb due to lack of cooperation.