Ultrasound for Carpal Tunnel
A New Way To Free the Median Nerve at the Carpal Tunnel with NO INCISIONS!!
Carpal Tunnel Median Nerve Neurolysis Under Ultrasound Guidance (Hydroneurolysis)
Carpal Tunnel Syndrome is the most commonly diagnosed neuropathy of the upper extremity. Originally described in 1854 by Sir James Paget the diagnosis and treatment of the disease as a compression neuropathy was popularized by Dr George S Phalen in the 1950‘s. Statistics report that 5 million adults in the United States have carpal tunnel syndrome, and there is a 10% risk of developing carpal tunnel syndrome in one’s lifetime. Reports indicate that 500,000 carpal tunnel releases are performed annually.
There are a variety of treatment methods for carpal tunnel syndrome with varied degrees of success. Those with proven effectiveness, such as wrist neutral splinting, therapy and injection offer relief in up to 70% of cases, and some studies indicate injection yields even higher success rates approaching 90% or higher, when performed under ultrasound guidance. The choice of optimal treatment depends on the severity, the duration of symptoms, and personal patient preferences.
Surgery generally requires a formal operating room setting along with the use of a tourniquet as well as either sedation or general anesthesia. Postoperative monitoring in the recovery room is generally required as well and a formal outpatient stay, either in a surgical center or hospital.
Variations include “open” incision release, mini open incision, and a number of endoscopic release techniques. Reported surgical success rates vary between 70% and 98% and reportings indicate that up to 25 or 30% of patients remain symptomatic or manifest early recurrence of symptoms.
Before Considering Carpal Tunnel Surgery
Before any Surgical Procedure is even considered using Ultrasound, the Median Nerve and Carpal Tunnel can be carefully and fully evaluated, in real time, much like when viewing an ultrasound of a baby in a pregnant woman. We see the nerve live and in real time. We can see how the nerve moves, what type of compression or pressure is on the nerve and the scar tissue and tendinitis around it.
This information is greatly helpful in developing treatment plans for therapy, splints, and home treatment, and indeed we have been able to help 70% of the patients we see avoid surgery for Carpal Tunnel.
Sometimes though, the scar tissue around the nerve is too thick and the nerve cannot heal adequately. Previously all we had to offer was Carpal Tunnel Surgery, and up to 30% of patients had ongoing or recurrent problems after the surgery.
Hydroneurolysis under ultrasound guidance is a procedure, much like open surgery, but with no incision, and greatly lessened risk and cost. Specifically, when used to address nerve pathology and scarring, as occurs in Carpal Tunnel and other nerve compression or fixation problems, we are able to free the nerve from its surrounding adhesions and scarring, as well as decompress the area utilizing fluid pressure to do what is normally done with scissor dissection. The technique is performed utilizing a probe, which emits ultrasonic waves, which then gives us visual pictures of the structures they are aimed through. The movement of the muscle or joint, ligament or tendon, paths of blood vessels and nerves can all be assessed in a real-time fashion. This allows us as surgeons to more readily evaluate pathology, observing how the tissues and structures change with movement and formulate more effective treatment plans.
Once the pathology has been confirmed, the area is numbed by placing an anesthetic patch in the area and the procedure is performed injecting a numbing fluid to free the nerve from the surrounding scar tissue, and or free it from a specific area of compression. Local anesthesia is used and done right in the office, with no need for any formal hospital stay, general anesthesia or recovery room for post operative monitoring.
Call us to find out more about how to avoid surgery for your carpal tunnel or nerve injury today!