Patient Education

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Did YOU
Know?

Women are three times more likely than men to develop carpal tunnel syndrome.

Symptoms

Symptoms of CTS start gradually and include frequent tingling, numbness and/or burning in the palm of the hand and fingers, especially the thumb, index and middle fingers. This pain can occur in one or both hands and is frequently worse at night.

What Causes CTS?

In your wrist, there is a space, called the carpal tunnel, which houses the nerves and tendons that lead to your hand. The roof of this tunnel is covered by a ligament called the transverse carpal ligament.

Through a variety of causes that include heredity, diabetes, pregnancy and occupation, swelling occurs in the carpal tunnel. This swelling compresses and puts pressure on the nerve causing the pain you feel in your hand.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a condition that causes pain, tingling, numbness and other problems in your hand due to pressure on the nerves in your wrist. It’s estimated that nearly 15 million people in the U.S. suffer from CTS. With early diagnosis, treatment for CTS has a high success rate and can help relieve nearly all painful symptoms.

Treatment Options

Treatment of CTS depends on the severity of your symptoms and recommendations of your doctor. Non-surgical treatments may include physical therapy, reduction of repetitive hand movements, night splinting and anti-inflammatory medication. More severe symptoms may require surgery that involves cutting the transverse carpal ligament.

Open Surgery

In open surgery, an incision (up to 2 inches) is made down the center of your wrist and palm through layers of skin and tissue to expose the transverse carpal ligament. That ligament is then cut to release the pressure on the nerve and relieve the symptoms of CTS.

While this method can be an effective option, open procedures have been associated with problems such as hypertrophic scarring, scar tenderness, and delayed rehabilitation. ₂, ₃, ₄

Endoscopic Procedure using the S.E.G-WAY™ System

Unlike open surgery, surgeons who use the S.E.G-WAY™ System cut a smaller, ½ inch incision in the crease of your wrist. With this minimally invasive approach, the surgeon performs the rest of the surgery using a tiny camera, called an endoscope.

While your treatment method should always be based upon your individual symptoms and the recommendation of your doctor, endoscopic surgery with the S.E.G-WAY™ System has a range of benefits.

The Research is on Hand

Having been performed for over 20 years, the benefits of endoscopic carpal tunnel release surgery are well documented:

  • “Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery.”

  • “The risk and complication rates for endoscopic surgery are very low. Major problems happen in fewer than 1 out of 100 surgeries (less than 1%).”

  • “This procedure gives a good surgical outcome with less scar tenderness and an earlier rehabilitation compared with OCTR (open surgery).” ₂, ₆, ₇

Endoscopic Carpel Tunnel Release (ECTR)More Info
The S.E.G-WAY™ System helps to:

  • Reduce recovery time, allowing for faster return to activities of daily life
  • Minimize scarring
  • Decrease post-operative pain

What is Cubital Tunnel Syndrome (Ulnar Nerve Entrapment)?

Cubital Tunnel Syndrome occurs when the ulnar nerve becomes compressed or irritated. It is also known as Ulnar Nerve Entrapment. It is the second most common peripheral nerve entrapment syndrome in the upper limb. Ulnar Nerve Decompression may be treated by both conservative and by operative means. The Ulnar Nerve travels from your neck down into your hand. There are five main locations where the ulnar nerve may be compressed around the elbow, Arcade of Struthers, medial intramuscular septum, medial epicondyle, cubital tunnel, deep flexor aponeurosis. Of these, the cubital tunnel is by far the most common. Depending upon where it occurs, this pressure on the nerve can cause numbness or pain in your elbow, hand, wrist, or fingers.

Treatment Options

Treatment of Cubital Tunnel Syndrome (Ulnar Nerve Entrapment) depends on the severity of your symptoms and recommendations of your doctor. Non-surgical treatments may include physical therapy, reduction of repetitive hand movements, night splinting and anti-inflammatory medication. More severe symptoms may require surgery that involves cutting the transverse carpal ligament using the Endoscopic or open technique. As with any surgical treatment there can be complications. Please consult your Physician.

Symptoms

Cubital tunnel syndrome can cause an aching pain on the inside of the elbow. Most of the symptoms, however, occur in your hand.

  • Ulnar nerve entrapment can give symptoms of “falling asleep” in the ring finger and little finger, especially when your elbow is bent. In some cases, it may be harder to move your fingers in and out, or to manipulate objects.
  • Numbness and tingling in the ring finger and little finger are common symptoms of ulnar nerve entrapment. Often, these symptoms come and go. They happen more often when the elbow is bent, such as when driving or holding the phone. Some people wake up at night because their fingers are numb.
  • Weakening of the grip and difficulty with finger coordination (such as typing or playing an instrument) may occur. These symptoms are usually seen in more severe cases of nerve compression.
  • If the nerve is very compressed or has been compressed for a long time, muscle wasting in the hand can occur. Once this happens, muscle wasting cannot be reversed. For this reason, it is important to see your doctor if symptoms are severe or if they are less severe but have been present for more than 6 weeks.
Endoscopic Cubital Tunnel (ECuTR)More Info

What is Plantar Fasciitis?

The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis.

Symptoms

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.

The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The pain is often worse in the morning or climbing stairs.

Prevention

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed.

Endoscopic Plantar Fasciitis (EPF)More Info

Treatment Options

Your health care provider will often recommend these steps first:

  • Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
  • Heel and foot stretching exercises
  • Night splints to wear while sleeping to stretch the foot
  • Resting as much as possible for at least a week
  • Wearing shoes with good support and cushions

Other steps to relieve pain include:

  • Apply ice to the painful area. Do this at least twice a day for 10 – 15 minutes, more often in the first couple of days.
  • Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
  • Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

  • Wearing a boot cast, which looks like a ski boot, for 3 – 6 weeks. It can be removed for bathing.
  • Steroid shots or injections into the heel

Sometimes, foot surgery is needed.

Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain. Some patients may not respond to non-surgical treatment and Open or Endoscopic surgical options are available. As with any surgical treatment there can be complications. Please consult your Physician.

What is Gastrocnemius Contractures?

An inability to achieve normal ankle range of motion is termed ankle equinus. The gastrocnemius and soleus muscles attach to the calcaneus. Contraction of these muscles moves the foot into plantar flexion. This is movement of the ankle joint or toes that point the foot downwards away from the leg.

Gastroc recession is performed to correct an isolated gastrocnemius equinus contracture of the ankle that may accompany foot and ankle pathology in the adult. Equinus deformity which is the upward bending of the ankle when the joint is limited, may lead to excessive strain throughout the foot, thus causing pain.

Endoscopic Gastrocnemius Recession (EGR)More Info

Symptoms

A gastrocnemius equinus contracture is characterized by the inability to bring the ankle joint past a right angle to the leg. This can manifest itself in the form of plantar fasciitis, metatarsalgia, posterior tibial tendon insufficiency, osteoarthritis, and foot ulcers.

Some causes of Gastroc Contracture are believed to be linked to diabetes, Immobilization, an hereditary predisposition or aging where muscles to tighten.

Treatment Options

Non-Surgical treatment like stretching of the calf muscle helps. However some patients do not respond and surgical treatment may be proposed. Two types of surgical treatment are available Open and Endoscopic release. As with any surgical treatment there can be complications. Please consult your Physician.

Clinical References:

  1. National Institute of Neurological Disorders and Stroke
  2. Agee JM, McCarroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study: J Hand Surg 1992, 17A:987–95
  3. Louis DS, Greene TL, Noellert RC. Complications of carpal tunnel surgery: J Neurosurg 1985, 62:352–6
  4. Palmer DH, Peulson JC, Lane-Larsen CL, Paulen VK, Olson JD. Endoscopic carpal tunnel release: a comparison of two techniques with open release: Arthroscopy 1993, 9:498–508
  5. Katz JM, Simmons BP (2002). Carpal tunnel syndrome. New England Journal of Medicine, 346(23): 1807-1812
  6. Chow JCY. Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome: Arthroscopy 1989, 5:19–24
  7. Okutsu I, Ninomiya S, Takatori Y, Ugawa Y. Endoscopic management of carpal tunnel syndrome: Arthroscopy 1989, 5:11–8
  8. Scholten RJPM, et al. (2007). Surgical Treatment options for carpal tunnel syndrome. Cochrane Database of Systematic Reviews (4)
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