Ultrasound guided carpal tunnel release

Brett Kindle, M.D., CAQSM, RMSK
Non-Surgical Sports MedicineAndrews Institute for Orthopaedics & Sports Medicine
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 Q: Why it Carpal Tunnel Syndrome such a common musculoskeletal surgical procedure?
Brett Kindle, M.D., CAQSM, RMSK: Carpal tunnel syndrome is essentially a phenomenon that happens due to impingement of the median nerve at the wrist. This usually presents with patients as numbness or tingling pain in their hand usually involving the thumb index and middle fingers. Oftentimes, it initially starts as waking up at night with numbness and it can progress to being painful throughout the day. As it progresses into its severity, it can produce weakness of the hand and loss of dexterity and can actually cause more pain shooting up the arm proximally toward the shoulder. It is very common. It is one of the most common musculoskeletal conditions that there are. There are several risk factors including repetitive use of the hands, which a lot of us are doing on a daily basis, as well as obesity and rheumatologic conditions do increase your risk for developing carpal tunnel syndrome.
 Q: What are the benefits to Ultrasound Guided Carpal Tunnel Release versus tradition carpal tunnel release procedures?
Brett Kindle, M.D., CAQSM, RMSK: The mainstay of treatment of carpal tunnel is carpal tunnel release surgery and classically this has been done by a mini-open technique where there is an incision that extends down into the palm of the hand. The skin over the palm of the hand actually takes quite a while to heal and so patients are often times out of work and activity for up to four to six weeks postsurgical. With carpal tunnel release under ultrasound guidance, we actually can make a very small 4-5 millimeter incision in the distal forearm, which does not involve the palm skin, and this actually will heal within a few days and patients usually can get back to full activity within a week.
 Q: What can patients expect to have happen when they are recommended to Ultrasound Guided Carpal Tunnel Release?
Brett Kindle, M.D., CAQSM, RMSK: So when a patient is diagnosed with carpal tunnel syndrome by a primary care physician or another provider and referred to me, initially they consult with me and I will evaluate them and see if I agree with the diagnosis at hand. If the diagnosis does appear to be carpal tunnel syndrome, then usually we obtain an EMG which is a nerve test to test how severe the carpal tunnel syndrome is. After that nerve test, if the severity warrants surgery, then I will do a diagnostic ultrasound looking at the nerve and the anatomy and the area of the wrist to make sure that they're a good candidate for the ultrasound guided carpal tunnel release. Then we proceed with the ultrasound guided technique. In the event that they're not a good candidate for the ultrasound guided technique due to anomalies in their anatomy, then I will usually just refer those to my surgical partners that do the mini-open technique.
 Q: What are the differences postoperatively between Ultrasound Guided Carpal Tunnel Release and tradition carpal tunnel release procedures?
Brett Kindle, M.D., CAQSM, RMSK: So with traditional carpal tunnel release surgeries, the time that patients are out of their normal activities is usually up to four to six weeks. That is a big advantage of the ultrasound-guided technique because we are allowing the patients to progress back to activity as pain tolerates, which usually is within a week. This is a big time difference. Patients are able to get back to work with normal activities much sooner. Additionally postoperatively, there is no immobilization required with the ultrasound guided technique, whereas with traditional techniques, usually the patient is required to wear a splint for a period of time. And the outcomes are the same postoperatively.


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