New Surgery Speeds Recovery From Painful Wrist Syndrome
A new surgical technique to repair carpal tunnel syndrome--the painful wrist problem that afflicts typists, laborers and others whose jobs involve repetitive hand motions--can speed the return to work by about three weeks, a Sacramento surgeon reported last week at a meeting of physicians in Toronto.
But some surgeons are taking a wait-and-see approach to the new surgery, saying they are worried that the risks may outweigh the benefits. And others say a variation of the new technique works even better.
Carpal tunnel disease begins when compression of one of the major nerves of the hand causes numbness, pain and tingling in the carpal tunnel, a bony passage in the wrist. Surgery to relieve the pressure on this median nerve is needed when non-surgical treatments fail.
The new surgery--called endoscopic carpal tunnel release--is similar to the arthroscopic surgery now popular to correct knee problems. The surgeon first makes a half-inch-long incision on the wrist of the patient, who is given general or regional anesthesia. The doctor inserts the endoscope, a special instrument for visualization, which also contains a device that cuts the carpal tunnel ligament, relieving painful pressure on the median nerve. Eventually scar tissue fills the gap and in effect lengthens the ligament.
At the annual meeting of the American Society for Surgery of the Hand, surgeon John Agee of Sacramento told colleagues that his study included 122 patients who underwent 147 carpal tunnel procedures--82 endoscopic surgeries and 65 conventional, or “open,” surgeries. He reported that patients who underwent the endoscopic procedure returned to work an average of 25 days after surgery, whereas those who underwent the conventional surgery took 46 days to return.
Endoscopic surgery patients also returned faster to daily activities, such as dressing and food preparation--nine days, compared to 13 for conventional surgery patients. All patients were followed up for 26 weeks, said Agee, who invented the Inside Job endoscopic cutting instrument that is used in the surgery and made by 3M.
Endoscopic patients wear a dressing for about 10 days after the operation and are in a splint for about three weeks. The procedure has been performed so far on more than 300 people.
Carpal tunnel syndrome has been called the new industrial epidemic. As many as 20% of employees in certain occupations, such as clerical work and construction, are at risk of developing cumulative trauma disorders, according to government estimates.
Proponents say the new procedure will replace “open” procedures, which require larger incisions and cutting through more tissue. But some orthopedic surgeons are reluctant to jump on the bandwagon.
“I think the indications for the new surgery are limited,” said Dr. Roy Meals, an orthopedic surgeon at Century City Hospital and UCLA’s chief of hand surgery. “In the average patient, the risks--such as nerve laceration--outweigh the benefits.”
Other surgeons are performing a variation of Agee’s technique. Dr. Charles Resnick, an orthopedic surgeon at Orthopedic Hospital in Los Angeles, said he learned a variation pioneered by Illinois surgeon James Chow.
The Chow method, also performed through the endoscope, allows better visualization, Resnick says, and makes post-operative splinting unnecessary. In the last year, he and his partner have successfully performed about 60 such procedures, Resnick said.
Most patients who are candidates for carpal tunnel surgery can undergo the endoscopic technique, said Dr. Jessica Cohen-Brown, a Santa Barbara orthopedic surgeon. Cohen-Brown trained at one of 10 sites where the Inside Job device was evaluated, and she recently performed the endoscopic surgery for the first time in her practice at the Sansum Medical Clinic. Inventor Agee agrees with her assessment.
But Cohen-Brown noted that it is important for patients to try conservative treatment first, such as activity modification, splinting and medication.
