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Minimally Invasive Surgery for Carpal Tunnel Syndrome Performed at St. Mary
Endoscopic carpal tunnel release yields extra benefits.

LANGHORNE, Pa., July 26, 2010 – A minimally invasive surgical option for people who suffer from the extreme pain and numbness associated with carpal tunnel syndrome is making a difference for patients at St. Mary Medical Center. Board-certified orthopedic hand surgeon David Cautilli, MD, who has fellowship training in hand and microsurgery, performs many carpal tunnel surgeries with a minimally invasive procedure known as endoscopic carpal tunnel release (ECTR). Carpal tunnel syndrome is a common orthopedic condition caused by pressure on the nerves in the wrist.

ECTR is performed under local or regional anesthesia in an outpatient surgical suite at St. Mary Medical Center using specialized instruments and a high-definition (HD) computerized viewing system. During the procedure, the surgeon guides an arthroscope and small surgical instruments through an approximately half-inch incision in the folds of the wrist. The arthroscope – a thin, lighted tube with a miniature HD camera at the tip – helps the surgeon view inside the affected area of the wrist known as the carpal tunnel. The surgical instruments are used to cut the transverse carpal ligament, reducing pressure on the compressed nerves running through the wrist and relieving symptoms such as tingling and numbness in the fingers or hand. The traditional open method of carpal tunnel release requires a larger incision in the palm of the hand which is more sensitive.

Regardless of how it is performed, “carpal tunnel release is a highly successful surgery, but ECTR – as with any other endoscopic procedure – yields extra benefits. These include less pain after surgery, less scar tissue, a faster return to normal activities, and a better cosmetic result for patients,” notes Dr. Cautilli.

After both open and endoscopic carpal tunnel surgery, physical rehabilitation is a frequent next step in recovery. Rehabilitation techniques range from simple at-home exercises to specialized rehabilitation with a certified hand therapist. The hand therapists at St. Mary Medical Center are highly skilled occupational therapists who have completed special training and earned advanced certification in rehabilitation for the complex structures of the hand, wrist, and elbow.

According to Dr. Cautilli, ECTR is an excellent treatment option for many of the patients he sees for severe or long-term carpal tunnel syndrome. Surgery usually is recommended after a patient’s symptoms have not responded to non-surgical treatments such as splinting or bracing, over-the-counter or prescription pain-relief medications, and changes in habits to reduce use of the swollen wrist tendons and nerves.

“Some exceptions are people seeking revision surgery for prior carpal tunnel release procedures and people with highly inflammatory health conditions such as rheumatoid arthritis. In those instances, traditional open carpal tunnel release may provide better outcomes,” he notes. The physician determines the best surgical procedure based on each patient’s medical needs.