Minimally Invasive

Arthroscopy
deQuervain's Release
Endoscopic Carpal Tunnel Release
Ganglion Excision
Needle Aponeurotomy (NA) Percutaneous Fasciotomy
OssaTron Extracorporeal Shockwave Therapy (ESWT) (Not available at this time.)
Synovectomy
Trigger Finger Release


deQuervain's Release

A deQuervain's release is the surgical treatment of deQuervain's tendonitis, also known as tenosynovitis, nonresponsive to conservative treatment. The procedure creates more space for the constricted tendons as they pass through a narrow tunnel in the wrist.

Generally performed as an outpatient procedure, the surgery begins with either an axillary block, in order to numb feeling in the arm, or other regional anesthetic to numb only the hand. The affected area is cleaned and a small incision is made along the thumb side of the wrist.

Soft tissue around the tendons is delicately moved aside in order to gain a clear view of the tendons. Another incision is made in order to split the roof of the tunnel and create more space for the tendons to move. Over time, the tunnel heals closed though remains larger - with scar tissue filling in the area where the tunnel was cut.

The skin is then sutured closed and the hand is wrapped in a dressing.

Following the procedure, pain is often quickly relieved, though tenderness may persist while the site of the incision heals. Sutures are generally removed 10 to 15 days after surgery.

A rehabilitation program will begin soon after the surgery and is key to a successful recovery and full resumption of hand function.

Endoscopic Carpal Tunnel Release

Endoscopic carpal tunnel release surgery is a very technical procedure designed to release a tight carpal tunnel and decompress the median nerve. The median nerve, which supplies sensation to the thumb, index, middle, and a portion of the ring finger, as well as supplying the thumb muscles, becomes compressed at the wrist in Carpal Tunnel Syndrome (CTS). The endoscopic carpal tunnel release technique divides the transverse carpal ligament, which is the roof of the carpal tunnel. This enlarges the volume in the carpal tunnel and decompresses the median nerve, relieving pain and discomfort.

There are numerous causes of Carpal Tunnel Syndrome, and endoscopic carpal tunnel release treats carpal tunnel syndrome associated with nearly all of these causes. Endoscopic carpal tunnel release is indicated when carpal tunnel symptoms persist despite conservative treatment, or when the severity of symptoms present with loss of hand function. Routinely, nerve conduction tests are ordered to determine the extent of damage to the median nerve as well as rule out any other neurologic conditions which may mimic carpal tunnel syndrome.

About the Procedure
Endoscopic carpal tunnel release is performed as an outpatient procedure, generally under regional anesthesia. The procedure lasts less than 20 minutes. Once the anesthesia has taken effect, the arm is exsanguinated and a tourniquet elevated to allow for the procedure to be performed in a bloodless field. A target point is placed at the base of the ring finger and the wrist is marked proximal to the flexion crease, where the incision is to be made. A small incision is then made in the wrist crease, and the entire procedure is carried out through this small incision. The proximal portion of the carpal tunnel is exposed through this incision, and the endoscopic instrument is inserted into the carpal tunnel, viewing the undersurface of the transverse carpal ligament. While viewed on the video monitor, the transverse carpal ligament is then divided from distal to proximal. Once complete division of the ligament is confirmed, the skin is closed with a single subcuticular stitch and a soft dressing is applied to the hand.

Following Surgery
Patients are able to move their hand and wrist immediately after surgery, although they are instructed to avoid heavy grasping, pinching, or lifting for the first two weeks. This helps to prevent the tendons from pushing up against the median nerve and promote the healing of the transverse carpal ligament. Patients are instructed to keep their dressing intact and dry (don't change it!) for five days. On the fifth day, the dressing can be removed and a Band-aide dressing applied to the incision. The first post-operative visit is scheduled ten to twelve days after surgery, at which point the single stitch is removed from the incision and patients are instructed in a home rehabilitation program of range of motion and stretching exercises.

Rehabilitation
A rehabilitation exercise program designed specifically for carpal tunnel is demonstrated at the first post-operative visit. Examples of these exercises are given to the patient in a handout for continued work at home. These exercises are key to a rapid and successful recovery. Occasionally, some patients may require formal therapy to improve their hand function.

Ganglion Excision

When a ganglion cysts fails to go away on their own or reappear following aspiration, a ganglion excision is perform, in order to surgically remove them. They most commonly form and are removed from the wrist joint.

The procedure is performed under either a local or a general anesthetic, depending on the health of the patient and other determinations made by the physician. A cut approximately as wide as the lump that forms the cyst is made in the skin, and the ganglion is removed.

The area is then closed with sutures and bandaged. A sling may be used for a short time following the surgery in order to reduce swelling.

Normal resumption of activity may begin once sutures are removed and pain no longer exists.

Needle Aponeurotomy (NA) Percutaneous Fasciotomy

Used in the treatment of severe Dupuytren’s contracture that is not responsive to conservative treatment, Needle Aponeurotomy (NA) is a minimally invasive procedure that involves the tip of a needle and tiny little puncture wounds. The surgeon guides the needle through the puncture wounds and divides the contracted palmar fascia. The procedure is performed under a local anesthesia and has a much shorter recovery time than open surgery.

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OssaTron Extracorporeal Shockwave Therapy (ESWT)
(Not available at this time.)

A new device called the OssaTron emits high-energy shockwaves that reduce inflammation and stimulates healing through a process called Extracorporeal Shockwave Therapy (ESWT). Utilizing extracorporeal shockwaves (ESW) and electrohydraulic or "spark gap" technology, the device was developed by HealthTronics Surgical Services in the treatment of chronic lateral epicondylitis, or chronic tennis elbow.

Initially created to treat kidney stone disease, the OssaTron ESW therapy is today producing positive results for 90 percent of chronic tennis elbow sufferers undergoing the treatment.

An outpatient procedure, OssaTron ESW therapy takes less than 20 minutes to perform and is indicated for patients, who are nonresponsive to other conservative treatment over a period of six months or more. The high-energy shockwaves are directly applied to the point of maximum tenderness, stimulating blood flow and encouraging the revascularization of degenerative tissue.

The physician begins the procedure by first marking the surgical site and area of tenderness. Either a local, or regional anesthesia, is administered and a high viscosity ultrasound gel is applied to the targeted area. The gel promotes shockwave conductivity for optimal effect. Hearing protection is worn in the treatment room in order to reduce the risk of hearing impairment from the ESW high-frequency sound. The patient's elbow is then firmly pressed to the treatment head and shockwave intensity is selected and applied.

Postoperative care entails refraining from activity that may irritate the elbow and a rehabilitation program that specifically addresses the condition and the types of activities contributing to it.

Synovectomy

Often used in the early treatment of rheumatoid arthritis (RA) or osteoarthritis (OA), a synovectomy removes the inflamed lining, or synovium, from the affected joint, alleviating the pain associated with diseased tissue inside the joint space.

The procedure is performed with either a general or local anesthetic depending on the health of the patient and other determining factors. It may also be performed as an open surgery or arthroscopically. If performed arthroscopically, the procedure begins with a small incision and an arthroscope is used to illuminate the problem areas within the joint. A sterile saline solution may be pumped into the joint in order to clean it and air may be used to expand the joint space for greater visibility.

The diseased tissue is then removed with small surgical tools and suction equipment. Before closing the wound, the surrounding area is carefully assessed for other tissue damage or floating debris.

The patient may require a sling for a brief period of time and a rehabilitation program is established in order to restore range of motion and strength.

Trigger Finger Release

When Trigger Finger, or Tenosynovitis, is nonresponsive to conservative treatment, trigger finger release is performed. The goal of the procedure is to enlarge the narrow part of the tunnel through which the tendons and associated "lumps" resultant from the condition must pass in the palm of the hand, relieving the constriction.

Generally performed on an outpatient basis under a local anesthetic, the band constricting the tendon as it passes through the sheath, or part of the tendon sheath that is causing the tendon to get stuck, is cut. The constricted area is immediately released, relieving pressure on the swollen tendon. The patient may be asked to move the fingers, in order to confirm that the tendon has been released.

Small sutures close the incision and a heavy dressing is placed over the wound. Day-to-day activity is encouraged several days post surgery and sutures are removed approximately two weeks postoperatively. Recovery is generally rapid and rehabilitative exercises help expedite return to normal hand function.