June 6, 2024

Getting back to daily activities more quickly is a major reason for eschewing the traditional open approach.

BACK IN ACTION The endoscopic approach is an excellent option for patients who would rather put off surgery than be forced to take time off from work for an extended recovery.

Carpal tunnel surgery is a common and exceedingly effective intervention for the numbness, tingling and outright pain that can be maddening for those suffering from the compressed nerve condition — but one surgical technique can help individuals get back to their daily routines more quickly.

With more than a half million procedures performed each year in the United States, carpal tunnel release surgery is a staple of ASCs and office-based facilities everywhere. While the procedure is highly successful via either the traditional open method or the newer endoscopic method, the latter is fast becoming the go-to option for many providers and patients alike. There are two major reasons for this: faster recoveries and smaller incisions.

In fact, a fear of being laid up even keeps certain individuals from scheduling a procedure that can vastly improve their quality of life.

"Patients can sometimes be hesitant to address carpal tunnel syndrome because they have busy lives and worry about taking an extended recovery period after surgery," said Derek Bernstein, MD, of Novant Health Orthopedics & Sports Medicine, in a recent article on the topic. Although Dr. Bernstein made it a point to state that all patients recover differently from surgery, he said he allows patients to go back to their daily activities as quickly as the day after their procedure if they feel comfortable following endoscopic surgery.

With the more invasive open procedure, patients are generally kept out of work for at least a week and are advised not to lift anything more than 10 pounds for at least a month to keep the incision from splitting open. Although the success and effectiveness of this approach aren’t an issue, the restrictions are enough of a reason to opt for the endoscopic approach. As Dr. Bernstein said, "It is a less invasive option that allows for a faster functional recovery."

The manufacturer of single-use devices is aiming to conduct the largest carpel tunnel release study in the U.S.

GUIDED BY SOUND Surgeons who are assisted by handheld ultrasound devices during carpal tunnel surgery can see anatomy in ways that allow for greater precision.

The manufacturer of a single-use handheld ultrasound device is conducting a multi-center clinical study to assess treatment of carpel tunnel release procedures assisted by the use of their product.

Sonex Health says the study aspires to be the largest carpel tunnel release study ever conducted in the U.S., with an enrollment objective of at least 2,000 patients at 19 surgical sites in 16 states across the country.

The physicians working on the study will screen patients to determine if they need a carpal tunnel release procedure. Patients who agree to participate in the study will undergo a surgery assisted by ultrasound guidance and provide post-procedure information for two years.

Stuart Hilliard, MD, FACS, a surgeon at North Texas Hand Center in Denton, enrolled the first patient into the study in March.

"I firmly believe in ensuring my patients are both knowledgeable about their condition and fully informed of the surgical and nonsurgical options to better involve them in their own care," says Dr. Hilliard. "Studies like this are crucial to being able to give patients the most up-to-date and useful information about their Carpal Tunnel Syndrome treatment options."

Real-time ultrasound guidance enables physicians to use a minimally invasive technique while performing a procedure through a small wrist incision by providing the ability to visualize critical anatomy. Performed using only local anesthesia, carpal tunnel release procedures assisted with handheld ultrasound devices can be performed in less expensive office-based settings, freeing up surgical suites in hospitals and ASCs for more complex procedures.

Compiling the database of outcomes from the patient will help Sonex determine how important its device, which received FDA clearance in 2019, is in helping surgeons find innovative therapies to provide affordable and safe minimally invasive care that allows patients to return to normal activities sooner than they would from traditional treatment methods, according to the company.

The impact of ECTR gives patients more options for their hand surgery and recovery.

More than 8.3 million people are diagnosed with carpel tunnel syndrome every year. Ambulatory surgery centers (ASCs) have become the place for patients to seek professional treatment and relief from this condition as the outpatient environment encompasses ever more service lines and ASC leaders evolve their offerings to accommodate community demand.

Carpal tunnel surgery can be performed endoscopically by way of a two-centimeter incision at the base of the wrist or through an open procedure where a one- to two-inch incision is made on the palm. Both techniques are safe and provide reliable positive outcomes. But both surgeons and patients do have preferences, so that leaves facility leaders asking themselves "Which option is best for our facility?"

Like the endoscopic release, open carpal tunnel surgery or OCTR — a technique that involves the surgeon making an incision at the base of the palm and cutting the transverse carpal ligament to release pressure on the median nerve — is a safe, dependable option with a long, proven track record of positive outcomes.

But from the patient’s perspective, there are two compelling reasons for surgeons to employ the endoscopic approach to carpal tunnel release surgery verses open surgery. One is practical and one is cosmetic. With the endoscopic release, a small incision is made at the base of the inside part of the wrist. Surgeons introduce the device through one end of the tunnel with the guidance of an endoscopic camera and deploy a knife that, under direct visualization, cuts the ligament.

One of the advantages to endoscopic carpal tunnel release surgery is that studies have shown patients return to work and normal daily activities sooner. Another advantage is the incisions are smaller. If you a patient is given the choice between a one-and-a-half-centimeter incision on the crease in their wrist with a speedy recovery prognosis or a four-to-five centimeter opening on the palm of their hand that takes a little longer to heal, they’ll naturally gravitate toward that smaller incision and quicker recovery. Overall, endoscopic carpal tunnel release is associated with reduced pain, more rapid return to work, and smaller aesthetic impact than OCTR.

Hand Biomechanics Lab has been a leader in developing instruments that support the surgeons who use the ECTR method to satisfy their patient needs. Dr. John Agee invented the single-portal, pistol grip ECTR device and procedure to help a patient who required the use of Canadian crutches to ambulate, making OCTR an undesirable treatment option.

Following 122 patients and 147 procedures, data showed 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 life activities such as dressing and food preparation, at 9 days compared to 13 for conventional surgery patients. Open procedures require larger incisions and cutting through more tissue, with a longer recovery time.

Today, Hand Biomechanics Lab is bringing value to this growing surgical market. The new drop-in replacement disposable blade assembly, for use with the 3M Agee Inside Job or MicroAire SmartRelease systems, is about half the price of the current standard system and is available in a six-pack. The Hand Biomechanics Lab blade assembly is distributed exclusively by Brasseler USA Surgical. The most important goal in any hand surgery is the safety of the patient – so it is important to evaluate the cost benefit as well as the patient’s needs when equipping your facility.

Note: For more information, visit https://handbiolab.com/ectr-blade-assembly/?activetab=ectr_video and watch this video.