Carpal tunnel syndrome is a condition that causes weakness, pain, and numbness in the hand and wrist. My patients often describe worsening of symptoms when driving a car, reading the newspaper, or holding a telephone. These symptoms are also worse at night and often wake people up at night. This syndrome occurs because of increased pressure on the median nerve in the wrist. The pain of carpal tunnel syndrome occurs more often around the palm side of the wrist and hand and may radiate to the forearm, shoulder, and neck. The median nerve gives sensation to the fingers so many patients describe a tingling or numbness there. Many complain of dropping objects they pick up or difficulty buttoning buttons.

What is the Carpal Tunnel?

The carpal bones of the hand form a “C” shaped ring that is covered by a ligament. There are eight of these bones that vary in size and shape to make up the wrist area. This ligament and bony structures form the carpal tunnel through which the median nerve and nine tendons pass. These tendons flex the fingers and thumb. Any condition that affects the size of this tunnel can lead to carpal tunnel syndrome.

What Causes Carpal Tunnel Syndrome?

There are several factors that lead to carpal tunnel syndrome. Most commonly, it is thought that the syndrome is genetic, while repetitive, strenuous use of the hands often worsens the symptoms.  Other conditions that can cause or worsen carpal tunnel syndrome include fractures, masses, severe bruising. Conditions that are associated with carpal tunnel syndrome include hypothyroidism, infections, arthritis, pregnancy, and diabetes.

How is Carpal Tunnel Syndrome Treated?

The first line of treatment is non-operative. Wrist braces, activity modification and anti-inflammatories are usually the first step and can be helpful in many early cases. Surgery is often considered when you do not gain relief from these treatments. Worsening symptoms indicate a nerve at risk of permanent damage.

The decision is based mostly on the severity of your symptoms and your desire to return to normal functioning. In the most severe cases, surgery is done much sooner because the other treatment options are not likely to help. Also, long-standing cases often require surgery when the disease has resulted in constant numbness and wasting of the thumb and finger muscles.

Surgical Treatment

Carpal tunnel release surgery is one of the most common operations performed on the upper extremity and is among the safest and successful surgeries I perform. During the surgery, I will make a small cut in the palm of your hand. This will allow me to see the transverse carpal ligament of the carpal tunnel and divide this structure to increase the size of the tunnel and decrease the pressure placed on the median nerve.

Once this is done, I close the skin and the ligament will start to heal and grow across the divided area. This new growth actually heals the ligament and more space is available for the nerve and flexor tendons. Once this is done, the skin is sutured and a sterile bandage is applied. The sutures will need to be removed in seven to ten days.

The endoscopic method for carpal tunnel release allows me to visualize the ligament with a small camera and the procedure results in a more speedy recovery. Other benefits of this procedure are less postoperative pain, earlier return to work, and earlier return of grip strength.

What Should I Expect during Recovery?

Immediately following your carpal tunnel release surgery, you will be instructed to frequently elevate your hand above your heart and move your fingers as well. This is done to prevent stiffness and reduce swelling. There is some pain, swelling and stiffness to be expected after the surgical repair. The dressing is removed in 3-5 days and normal use of the hand is allowed once you are comfortable. Minor soreness of the palm region is common but reliably improves over time.

Arthroscopy

Arthroscopy is a common surgical procedure in which a joint is viewed by means of a small camera. The camera is inserted after the surgeon makes a small incision. The arthroscope allows the orthopedic specialist a clear view inside the knee to help diagnose and treat knee conditions.

Technological medical advances have afforded our surgeons high resolution cameras and high definition monitors. These and other advancements have made arthroscopic knee surgery an effective means for repairing damage to the knee and treating common knee problems.

What is involved with knee arthroscopy?

During an arthroscopic knee procedure, your orthopedic surgeon will insert a small camera instrument the size of a pencil into your knee joint. This device is called an arthroscope and it sends the image of the inside of your knee to the TV monitor the doctor watches.

On this monitor, he can see the knee structures in great detail. This allows him to feel, remove, and repair damaged tissues and structures.

How do I prepare for this surgery?

Be assured, almost all knee arthroscopies are done on an outpatient basis. If your doctor recommends a knee arthroscopy, you may need to undergo a complete physical examination with your family doctor prior to the surgery. He will check your health status and identify any problems that would interfere with the procedure.

Before surgery, you should tell the orthopedic specialist about any medications or supplements you are taking. He may tell you to stop taking these a few days before the procedure. You can expect that your surgeon will order some pre-operative tests before the surgery, too. These may include blood counts, X-Rays, and electrocardiogram (EKG).

What type of anesthesia will the surgeon use?

When you arrive to the outpatient surgery center, a member of the anesthesia team will want to speak with you. Knee arthroscopy can be done under regional or general anesthesia. While local anesthesia alone can be used for knee arthroscopy, it is not recommended because of more discomfort during the procedure and the lack of relaxation of the muscles during the procedure which you do get with regional or general anesthesia.

Regional anesthesia will numb you below your waist and general anesthesia puts you to sleep. The anesthesiologist will help you decide which type of anesthesia is best for you.

What can I expect during the procedure?

After you receive your anesthesia, the orthopedic specialist will make a few small incisions in your knee. Then, he will inject a sterile solution into the knee joint to rinse away any cloudy fluid that will obscure his view. First, the surgeon will introduce the arthroscope into the knee and use the TV monitor to guide him.

If your doctor sees that surgical repair is necessary, he will insert tiny instruments through other small incisions to do this. These could include scissors, graspers, and motorized shavers. Overall, the procedure generally lasts around 30 minutes to an hour. How long it takes really depends on what the surgeon finds and the treatment that is necessary.

Your surgeon will close your incisions with stitches or Steri-Strips and cover them with a dry, clean bandage. You will be moved to a recovery area for about an hour before being released. You will need to have someone there to drive you home.

Knee arthroscopy is most commonly used for:

• Removal or repair of torn meniscal cartilage
• Removal of loose fragments of bone or cartilage
• Reconstruction of a torn anterior cruciate ligament
• Trimming of torn pieces of articular cartilage
• Removal of inflamed synovial tissue

What can I expect during the recovery period?

You will recover from arthroscopic knee surgery quicker than from traditional open knee surgery. It is very important for you to follow your orthopedic surgeon’s instructions carefully after you go home.

Dressing Care – When you leave the hospital, you will have a dressing covering your knee. Be sure to keep this clean and dry. Your surgeon will tell you when it is alright to bathe or shower and when and how to change the dressing. Don’t remove the stitches or Steri-Strips.

Swelling – Keep your leg elevated as much as possible for the first couple of days after your arthroscopic knee procedure. You can apply ice as recommended by your doctor to relieve pain and swelling.
Bearing Weight – Most patients will not need crutches or a cane after knee arthroscopy. Your orthopedic specialist will tell you when you are to put weight onto the leg and foot.
Driving – Your doctor will tell you when you may drive. This decision will be based on several things, including your level of pain, the nature of your procedure, the knee that is involved, whether you have a stick shift or automatic car, and how well you can control your knee.

Generally, patients can drive within a few days after this procedure.
Medications – Your doctor will give you medications to help relieve discomfort following your knee arthroscopic procedure. Sometimes, a medication like aspirin is recommended to lessen your risk of blood clots.

What exercises can I do to strengthen my knee?

Your doctor will recommend an exercise program for you following your arthroscopic knee surgery. This is done to restore motion and strengthen the muscles of your knee and leg. Therapeutic exercises are important for a speedy recovery. Sometimes, the surgeon finds it necessary to set you up for formal physical therapy to improve your final result.

When can I get back to my normal routine?

Typically, you are able to return to your normal physical activities within 4 to 8 weeks. Higher impact activities, such as running and aerobics, may need to be avoided for a longer periods of time. You will need to discuss this with your orthopedic specialist to make sure you don’t further damage your knee joint.

The final outcome of your surgery is largely determined by the degree of damage to your knee.

Many athletes develop shin splints, a condition called tibial stress syndrome by doctors. Whether you are running a marathon or just sprinting to catch the bus, you feel a throbbing or aching in your shins and that’s shin splints.

Shin splints are not a real medical condition but a symptom of an underlying problem.

This symptom could be the result of irritated and swollen muscles from overuse, stress fractures (tiny hairline breaks in the lower leg bones), over pronation from flat feet causing the arch of the foot to collapse and stretching of the muscles and tendons to occur. … read more

Elbow arthroscopy involves the use of fiber optics and a tiny camera for the diagnosis and treatment of many elbow conditions. With this procedure, small incisions are made around the elbow joint to allow the camera to show a magnified picture on a TV monitor in the operating room. When the surgery is done to treat a diseased or injured joint, the orthopedic specialist inserts tiny surgical instruments through the incisions to make the necessary repair.

Because elbow arthroscopy uses smaller incisions and the joint is not open and exposed, there is minimal injury to the surrounding soft tissues. What’s more, this technique allows the orthopedic surgeon to view inside the elbow joint from a variety of angles, allowing for a thorough evaluation and more appropriate treatment regimen.

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What is Done Before the Procedure?

Before the surgeon performs your elbow arthroscopy, he will examine your elbow, discuss your history, and usually obtain x-rays of the joint. He may then obtain special imaging (CT scan, MRI scan) to help in diagnosis and planning. These images allow him to obtain information about the soft tissues that surround the bones. These tissues include cartilage, tendons, and ligaments.

Sometimes, the bones themselves have irregularities such as spurs or extra growths that could lead to inflammation and pain. Placement of the incisions is guided by these test findings and they are an important part of your treatment plan.

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What Conditions are Treated with Elbow Arthroscopy?

Elbow arthroscopy is used as a diagnostic and treatment measure for stiffness, loss of motion, and pain of the joint. Some conditions that are diagnosed include:

• Adhesions – soft tissue bands that permit full motion
• Injuries – fractures and torn or degenerative tissues (e.g. tennis elbow)
• Contracture – problem where the tissues are contracted, limiting range of motion
• Loose bodies – bone fragments and pieces of cartilage
• Arthritis – a disease that involves the wearing away of cartilage that is necessary for the bones to glide smoothly against each other

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How Does the Doctor Perform Elbow Arthroscopy?

Elbow arthroscopy is usually done using general anesthesia (put you to sleep). After you receive adequate anesthesia, the orthopedic specialist will create incisions known as ‘portals’ that allow him to gain access to the elbow joint. These portals are put in exact locations that help minimize the potential for swelling and complications.

The small camera is placed through one of these incisional portals while the instruments go in others to repair and correct the condition.

The length of the procedure will vary depending on what the surgeon has to do. After the operation, the surgeon will put you in a soft bandage and splint to support your surgical site. Most patients work with our physical therapist following the procedure to regain maximum range of motion and strength of the joint.

The length of your rehabilitation will depend on the extent of damage to your joint, the procedure performed, and how healthy you are going into surgery.

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What are Some Reasons for Getting Elbow Arthroscopy?

Not all conditions of the elbow are treatable with arthroscopy. Some of the reasons the orthopedic specialist will perform an arthroscopic elbow surgery include:

Removing Loose Debris – The elbow joint can accumulate loose cartilage or other debris as a result of injury or arthritis. These loose bodies within the joint can cause limited range of motion, stiffness, and pain. Arthroscopic elbow surgery is a minimally invasive way to remove this difficult debris.

Removing Bone Spurs – Bone spurs can form in early stages of elbow arthritis, and these growths impede normal motion of the joint. An arthroscopic elbow procedure may be appropriate to remove the growths to eliminate pain and restore more normal motion of the elbow joint.

Thrower’s Elbow – A specific elbow problem known as ‘thrower’s elbow’ occurs in athletes such as baseball pitchers who throw a lot. Because of the tremendous forces on the elbow, a bone spur can form in the back of the joint and this leads to inflammation and pain. If nonsurgical treatments fail to relieve these symptoms, an elbow arthroscopy may be helpful to remove this growth and restore use of the joint.

Loosening the Joint Capsule – The elbow joint is notorious for stiffening as a result of surgery, injury, or other trauma to the joint. This condition is called elbow arthrofibrosis. With this condition, the elbow joint capsule may become so tight that motion is decreased and limited.

Surgically loosening the joint capsule is possible in some of these patients. The advantage of an arthroscopic approach is that less scar tissue is likely to form after the procedure making the chance of regaining motion highly probable.

Assessing Cartilage Damage – Many cartilage problems are the result of osteochondritis dissecans (OCD). This leads to problems with the mobility of the elbow joint. X-rays and MRIs may not adequately show the extent of the damage, so arthroscopic surgery can be used to assess the extent of cartilage damage and determine if further treatment is necessary.

Tennis Elbow – This condition occurs when there is microscopic tearing of the tendons on the outside of the elbow joint. Many people improve without surgery, however, some do not and surgery is required.

The traditional arthroscopic procedure detaches the tendon from the bone, removes the damaged tissue, followed by a repair or reattachment of the tendon.

What is Carpal Tunnel Syndrome?

The “carpal tunnel” is a tunnel-like structure of the wrist. The wrist bones called the carpal bones form the floor and walls of the tunnel. The roof of the carpal tunnel is a strong band of connective tissue called the transverse carpal ligament.

The median nerve travels through the carpal tunnel and this nerve provides sensation to the palm side of the thumb, index, middle and half of the ring finger. It also controls the muscles of the thumb. Flexor tendons travel through the carpal tunnel with the median nerve. These tendons are necessary to bend the fingers and thumb.

Carpal tunnel syndrome occurs when the tissues adjacent to the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium and they lubricate the tendons to make it easier to move the fingers. With carpal tunnel syndrome, the synovium swells and narrows the confined space affecting the median nerve.

What is Involved with Endoscopic Carpal Tunnel Release Surgery?

Endoscopic surgery involves the use of a small camera. This small camera is known as an endoscope and it is guided through a one centimeter incision in the wrist to view the inside of the carpal tunnel. The endoscope allows the orthopedic hand specialist to see the structures of the wrist without opening the entire area with a large incision.

The transverse carpal ligament is cut during endoscopic carpal tunnel release surgery and this ‘releases’ the pressure that is on the median nerve and thus relieves carpal tunnel syndrome symptoms. The small incision made to the surgical site are closed with sutures and the ligament that was cut will eventually heal by being filled with scar tissue. This type of procedures is done on an outpatient basis, with most patients receiving sedation and arm “block”.

Why Is Carpal Tunnel Release Surgery Done?

If you still have symptoms even after a long period of nonsurgical treatment, your orthopedic specialist may recommend carpal tunnel release surgery. If there are signs of nerve damage, the surgeon may urge you to consider this procedure immediately. Another reason the surgery is done is that severe symptoms that persist restrict your activities of daily life.

How Well Does It Work?

Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand afterwards. In rare incidences, however, the symptoms return or there is temporary loss of strength when gripping or pinching objects. The surgery works best when there is no nerve damage or serious damage to the internal structures of the wrist. If the muscles are wasted away or weakened before the surgery, there is more likelihood that there will be decreased hand strength and function after the procedure.

What Should I Expect After Surgery?

There is a shorter recovery period after an endoscopic surgical procedure than after open surgery. This is because the structures of the hand and wrist are not manipulated and there is less of an incision to heal. The pain and numbness due to nerve compression should be relieved immediately following the endoscopic carpal tunnel release surgery.

You will have to avoid heavy use of your hand for two or three weeks following this procedure. Your doctor will advise you on when you can return to work and this will depend on whether or not your dominant hand was operated on, what is involved in your work activities, and the effort that you put into your rehabilitation and physical therapy.