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CARPAL TUNNEL SYNDROME


WHAT YOU SHOULD KNOW

The carpal tunnel is a space near the wrist and palm where 9 tendons and the median nerve make a narrow passage under a tight band of tissue, the transverse carpal ligament. Carpal tunnel syndrome is when the tendons swell so much in the tight space that they put pressure on the nerve. Everyday use of the hands and certain positions of the wrist during daytime and nighttime, in certain instances, may be the only cause.

MEDICAL HISTORY

Patients usually complain of pain, numbness, and tingling that begins in the wrist region and travels out to the fingertips of the thumb, index, long, and ring fingers. The symptoms are often worse in the middle of the night causing waking or in the morning. Driving, fixing one's hair and time at the computer are other problem activities. When severe patients may even lose coordination and drop things.

carpal_tunnel_syndromeEXAMINATION

Pressure applied over the nerve at the wrist will recreate the pain, numbness, and tingling. The doctor will measure strength in the muscles (motor) and feeling ability (sensory) in the skin for specific areas serviced by the median nerve. In more advanced conditions, patients will demonstrate loss of motor and sensory functions.

ADDITIONAL TESTS

Electrical nerve tests provide actual numbers that tell the story of how well or poorly the nerve is conducting signals in the area of the carpal tunnel and if the muscles have sustained any damage as a result of prolonged nerve pressure.

TREATMENT OPTIONS

Despite what you may hear, Endoscopic Carpal Tunnel Release (ECTR) is not a new procedure, nor was it developed here in Houston. It was originally developed in 1987 by Dr. James Chow, MD, a highly respected hand surgeon in Illinois. Although some surgeons try to make this procedure seem unique by giving it a special name, it is still just a carpal tunnel release using a fiber-optic camera called an endoscope.

The correct (and fully inclusive) procedure code (CPT) used to bill an endoscopic tunnel release is 29848. As of 4/5/2013 our usual and customary fee for this procedure is $1,053.78. Please call for an up to date price. This fee does change frequently and most insurance companies and government payors such as Medicare either negotiate or legislate a discount for themselves.

Patients should be aware of several small but important differences among the various ways to view the inside of the carpal tunnel with an endoscope while cutting or “releasing” the carpal ligament with a blade. Perhaps the most important difference has to do with safety. In procedures where the surgeon operates the camera and the blade separately through two incisions, it is an unfortunate complication when the median nerve is accidentally cut.

The ECTR equipment Dr. Henry uses was developed by Dr. John Agee, MD, a hand surgeon in California. The design affixes the camera on the retractable blade at all times, which allows the surgeon to see exactly where, and what, the blade will cut. The endoscope and blade assembly all work together as a unit inserted through a single 1cm incision, with the blade retracted in the default position, and thus unable to inadvertently cut anything (like a nerve or tendon) until the surgeon chooses to deploy the blade. We believe this is the safest method for ECTR.

  NON-OPERATIVE ENDOSCOPIC CARPAL TUNNEL RELEASE
CONSISTS OF Night splints, ergonomic training, and cortisone shots into the carpal tunnel Release of the tight band, taking pressure off the nerve
FEATURES Limit of 2 cortisone shots designed to shrink tendon swelling Brief outpatient surgery using a fiber optic camera via a single 1cm incision at the wrist.
ADVANTAGES Avoids surgery Definitive solution to problem
DISADVANTAGES Only effective in mild cases Always the risk of scar tissue forming near nerve

RECOVERY

After the surgery no splints are used and there are no sutures that will need to be removed. Immediate use of the hand is encouraged for all light activities of daily living. Even forceful or heavy use of the hand is possible immediately, but such early over activity will be painful and is not encouraged. Specific therapy exercises should be done to limit scarring around the nerve. Return to a normal lifestyle is quite rapid.
 
 
 
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  • Outstanding care throughout my surgery treatment and followup care - 04/14/14
  • If there was a category over outstanding I would have checked that one! - 03/07/14
  • Wonderful to find a Doctor who still strives to fulfill his Oath as a healer! Thank You - 07/02/13
  • Had I known this process would be as successful and pleasant as it was, I would have done it years ago. - 04/19/13
  • very outstanding visit and the personal all where outstanding. Doctor is very outstanding. thank you for getting me in at the short notice. thank you again - 02/27/14
  • Outstanding Staff - 05/14/13
  • Everyone in the office was professional kind and attentive. I would recommend friend/relative to this office. Thank you for your care. - 04/26/13
  • I AM SO GLAD I CHOSE THIS DR HE IS GREAT AND SO IS ALL STAFF MEMBERS - 04/18/14
  • Dr. Henry is excellent! I would recommend him to any one! My experience was very comforting. - 07/18/13
  • I'll like to thanks all the staff,they are very outstanding emlploee very kind ,nice,very patience with me to explaining every thing that is going on and thank you all so much - 05/29/13
  • Quick but well done! - 07/02/13
  • Thank you! - 09/06/13
  • Most professional and helpful for a first fracture in my life at 60 years old. Loved all staff and therapy. Thanks - 02/25/14
  • could not be better - 02/19/14
  • I look forward to healing. Thank You Doctor and Staff. - 02/20/14
  • This is a great environment and I would definitely recommmed this place to others. I am very pleased of the outcome of the surgery! - 10/15/13
  • Everyone was friendly and professional.I would return if needed. The girl at the front desk is an asset to your office. - 08/01/13
  • Awesome as always :) - 02/24/14
  • keep up the great work - 07/10/13
  • ifeelgreat - 07/15/13
  • I was going to therapy here and Courtney was my therapist - she was Great! She was concerned and helpful. - 06/04/13
  • The Dr took my appointment last minute. I'm very appreciative of that. - 03/04/14
  • really glad i chose to come here, every aspect of service was great - 04/01/14
  • Rock on! - 05/07/13
  • Under the circumtances, the staff was excellent, but Teresa was awesome throughout the unpacking and packing of the wound. Thank you Dr. Henry for saving my finger. Leanora - 05/03/13
  • Ya'll were awesome! I did't mind the waiting length because everyone was helpful, focused and very attentive when they arrived. I"d type more, but I"m mildly incapacitated. - 11/22/13
  • Very happy w/my visits and the care shown to me. I was fit in b/c of cat bite and severe swelling in my primary hand on a week of holiday...THANK YOU! - 11/27/13
  • Thank you so much for taking my concerns and wishes into consideration and allowing me to try the removeable splint. Your staff were all wonderful, and I really appreciate their efforts, kindness and consideration. - 09/05/13
  • Thanks to the entire staff. Wonderful experience. - 11/22/13
  • I BELIEVE THAT I AM IN GREAT HANDS WITH DR. HENRY AND HIS STAFF AND I APPRECIATE THE CARE HE SHOWED TODAY DURING MY VISIT. THANK YOU - 10/08/13
  • mine was an excellent experience from appointment desk all the way through surgery and physical therapy. This is an extremely knowledgable and professional doctor and staff. - 10/29/13
  • From the first call everyone I have encountered has been amazing! Thanks - 06/05/13
  • This is the best of the BEST! - 01/08/14
  • Thank you!!! - 10/09/13
  • The entire staff was outstanding in assisting me before and during the appointment. I appreciate all they did helping me from out of town. - 07/19/13
  • You guys are awesome - 07/03/13
  • Thanks so very much to all of you ..Venanzia Grafton - 05/29/13
  • First experience with hand trauma and i was well taken care of and information regarding my issue was thouroughly explained! thank you. - 09/10/13
  • Discussed all of my options. Listened carefully to what I said and suggested different options that would help me to gain satisfaction. - 02/26/14
  • Wish I would have come to Dr. Henry years ago! Staff courteous and helpful. - 04/14/14
  • I had an excellent experience. thank you and your staff. - 09/06/13
  • Dr. Henry, as in the past, engendered my confidence and gave me peace of mind as a result of his exam and explanation. - 04/22/14
  • dr henry was extemely thorough luis was very helpful and exceptionally friendly with one hand only david was very friendly as well and very good at placing the splints. - 09/05/13
  • Most organized and efficient doctor visit of my life. Excellent. - 06/12/13
  • I am very well satisfied with the outcome of this surgery. All involved here at the doctor's office and hospital were very friendly, professional and considerate. Thank You! - 06/21/13










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