Minimally Invasive Treatments

Endoscopic Carpal Tunnel Release

Carpal tunnel syndrome can be treated with carpal tunnel release Surgery. Traditional surgery involves up to a 2- inch incision in the palm and wrist area, whereas endoscopic surgery involves one or two half-an-inch incisions and the use of an endoscope. During the surgery, the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. Your surgeon will decide which options are best for you based on your general and medical conditions.

Procedure

In endoscopic surgery a thin, flexible tube with a camera (endoscope) attached is to its end is employed. In single-portal technique a small incision is made in the wrist while in two-portal technique two incisions are made, one each at the wrist and palm. The endoscope is inserted through the small incision and helps the doctor visualize the internal structures at the wrist such as the transverse carpal ligament avoiding the need for a large incision.

When the ligament is located, a tiny cutting tool is employed to release the ligament. In the single-portal technique, a single small tube contains both the camera and the cutting tool, whereas in two-portal technique the camera and cutting tool are inserted through different incisions. After insertion of the cutting tools through the respective incisions, the transverse carpal ligament is cut. This releases the pressure on the median nerve and alleviates the symptoms of carpal tunnel syndrome.

The small incisions are closed with stitches. The ligament will heal with the development of scar tissue around the cut ends.

Post-operative care

Patient having carpal tunnel release surgery can be discharged home the same day.
Your surgeon will suggest certain post-operative procedures for a better recovery and to avoid complications.

  • Elevate the hand above heart level to reduce swelling
  • A splint may be worn
  • Ice packs to the surgical area to reduce swelling
  • Keep the surgical incision clean and dry; cover the area with plastic wrap when bathing or showering
  • Physical therapy may be ordered to restore wrist strength
  • Eating a healthy diet and not smoking will promote healing

The majority of patients do not suffer any complications following carpal tunnel release surgery but as with any surgery, complications can occur and can include continued pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

Xiaflex

Dupuytren’s contracture is thickening of the fibrous tissue layer under the skin of palms, fingers, and hands which leads to curving of the finger. It is caused due to the excessive production of collagen which gets deposited under the skin. Hereditary factors, excessive alcohol consumption, diabetes, seizures, and increased age may increase the risk of developing the condition.

The most commonly observed symptoms of Dupuytren’s contracture are lumps or nodules in the palm, difficulty in straightening the finger, and contracture of the nodules which forms tough bands under the skin.

Treatment with Xiaflex

Dupuytren’s contracture can be treated by both non-surgical and surgical methods. The new and effective treatment for Dupuytren’s contracture is treatment with Xiaflex (collagenase Clostridium histolyticum). Xiaflex is comprised of two collagen enzymes that have hydrolytic activity and breaks the collagen that causes contracture.

Xiaflex, 0.58 mg is directly injected into the palpable Dupuytren’s cord that affects the proximal interphalangeal (PIP) joint or metacarpophalangeal (MP) joint. After 24 hours of injection, your physician will perform finger extension procedure to bring about cord disruption.

If the contracture persists after the Xiaflex injection, the finger extensions and subsequent injections are administered once in four weeks and maximum of three times per cord. Injection is given to one cord at a time. If an individual has contracture in other cords then the injection is given in sequential order.

The common side effects of Xiaflex include fluid builds up in the tissue, lymph nodes in the elbow or underarm swells up, bleeding, pain and tenderness in the injected area, and itching. However, these risks are mild and moderate and can be resolved.

Your surgeon will ensure that Xiaflex is not injected into surrounding healthy collagen- containing structure such as the tendon and ligament, as it may result in the permanent damage of the tendon or ligament. However, this can be treated by surgery to fix the damaged structure.

Please inform your physician if you are taking any prescribed medicines or non-prescribed medicines. Also, individuals with anti-coagulants disorders who are taking aspirin, Coumadin®, Plavix®, or Effient® should discussed physician before initiating Xiaflex.

Arthroscopy

Arthroscopy is a minimally invasive procedure used to see, determine, and treat abnormalities in your joint. You may be recommended a small joint arthroscopy by your surgeon to confirm a diagnosis or treat the small joints in your fingers known as the metacarpophalangeal (MCP) joints and the bones and ligaments in your wrist and elbow joints.

Indications

Some of the indications for small joint arthroscopy include pain, loose bodies, fractures, cysts, ligament tears, synovitis, lesions, arthritis, and inflammatory conditions of the small joints.

Technique

Once your hand and arm are numbed (regional anesthesia), a small incision is made on your skin over the joint and a narrow fiber-optic tube fitted with a small camera and lighting system is inserted through the incision directly into your joint. The camera lens allows your surgeon to magnify and project small structures in your joint onto a monitor. Your surgeon will then place special miniature surgical instruments, such as graspers, forceps, probes, currettes, and dissectors into your joint to help diagnose and treat your small joint abnormalities. On completion of the procedure, you will be either splinted or a protective bandage will be applied. The duration of protection will depend on your specific procedure. You will be instructed to keep your hand elevated in order to prevent excessive swelling and pain.

Advantages

Arthroscopy requires far smaller incisions compared to traditional surgery, and considerably decreases your risk of infection, blood loss, and scar tissue formation.

  • The use of small instruments results in very minimum damage to the surrounding skin and soft tissues, causing less discomfort and enabling a quicker recovery.
  • Most arthroscopic procedures are day case procedures and require no overnight stay in the hospital.
    Risks
    • Complications with small joint arthroscopy are rare and uncommon. Some of the potential risks during or after your procedure include injury to the nerves or tendons, infection, bleeding, scarring, and excessive swelling.

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