| PERIPHERAL
NERVE Surgery
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Carpal Tunnel Syndrome
The standard way of doing this
is by making a small, one and a half inch, incision in the base of
the palm. Through this incision, the surgeon under direct vision
carefully releases the tight ligament covering the carpal tunnel.
This is done as an outpatient procedure (patient goes home
the same day) and, unless the patient requests general anaesthesia,
is done by just numbing the arm or hand.
Following surgery relief of carpal
tunnel symptoms is often immediate. A soft dressing and no cast is
used for 3-5 days and in most cases in 6 months the incision is
almost invisible.
Another way to do the surgery is the endoscopic
technique. Through a small 3/4 inch incision at the base of the
palm the surgeon puts a small telescope into the tunnel. Using a
small knife inside the tube the surgeon then cuts the ligament to
release the tunnel. The advantages are a smaller incision. I however
do not recommend this technique because there is a higher risk of
injury to the nerve because the surgeon cannot see the anatomy as
clearly as in the standard technique which already has a small
incision and does so well.
Ulnar Transposition
The surgical procedure of choice is
referred to as an Ulnar Transposition. As constant stretching
and compression of the nerve in the Olecranon notch is the culprit,
simply moving the nerve to the topside of the elbow, is often
sufficient in stopping pain. This transposing of the nerve
will often stop further muscle wasting as well, but any atrophy
present in the hand, is generally irreversible.
SOURCE: American
Society for Surgery of the Hand
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