New carpal tunnel surgery 'minimally invasive'

Blake says endoscopic surgery good effective for carpal tunnel sufferers

lgierer@ledger-enquirer.comNovember 4, 2013 

Mike Haskey mhaskey@ledger-enquirer.com Dr. Sean Blake discusses doing carpel tunnel surgery endoscopically. 10/29/13

MIKE HASKEY — mhaskey@ledger-enquirer.com Buy Photo

John Lian says when he moved his right hand a particular way the sting was like an electric shock. Pain would wake him in the middle of the night.

"It was like there were needles in my hand," Lian said.

The 38-year-old Phenix City man's problem with carpal tunnel syndrome came to an end six weeks ago when an endoscopic carpal tunnel release surgery performed by Dr. Sean Blake fixed the problem.

The surgery lasted about 15 minutes.

Lian said he has no pain, and he can barely see the tiny scar on his wrist.

Lian had struggled with symptoms for about 18 months. It affected his work installing beverage equipment, which calls for heavy lifting.

His wife, who works for the Bradley Center, heard a new hand surgeon was in town and suggested Lian see him.

Blake, 40, arrived in Columbus from Buffalo, N.Y., nine weeks ago to be the director of the hand center at the St. Francis Orthopedic Institute and brought the relatively new procedure with him.

Blake found out about the opening here from Dr. George Zimmerman, whom he met at a conference.

"I wanted to come south," Blake said.

He has a wife, Bridgette, and three young children, Bo, Josi and Tony.

Blake said endoscopic carpal tunnel release surgery is minimally invasive.

"The long-term results are the same as the traditional open surgery, but the short term is better," he said. "The recovery is quicker."

Carpal tunnel syndrome occurs when the median nerve becomes pressed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers as well as impulses to some small muscles in the hand that allow the fingers and thumb to move.

Blake said the thumb, middle and index fingers are most affected.

The carpal tunnel is a narrow rigid passageway of ligament and bones at the base of the hand that is home to the median nerve and tendons. Sometimes thickening of the transverse carpal ligament narrows the tunnel and causes the median nerve to be squeezed.

Blake said that to relieve the pressure on the median nerve, the transverse carpal ligament must be cut. While this may relieve the symptoms it does not affect the use of the hand. There might be some weakness, which can be strengthened through physical therapy.

In the traditional open carpal tunnel surgery, an incision of up to two inches is made along the base of the palm.

With endoscopic surgery, an incision of about a centimeter is made. Blake said he then inserts a tiny tube with a camera, an endoscope and blade attached to it. The cut is then made.

Blake said that some patients will not qualify for the endoscopic procedure because of other complications in the troubled area.

Blake said symptoms of carpal tunnel syndrome include a tingling in the fingers, some numbness. The fingers can feel swollen though they are not. There can be some pain in the wrist.

"People may notice a weakness in their hand," he said. "You start dropping things. You have trouble buttoning a shirt."

Blake said he conducts several tests on patients to see if carpal tunnel syndrome is the problem and not some other condition, such as tendinitis.

"That testing starts when I first meet you and shake your hand," he said.

He said in some cases the problem can be eased with physical therapy.

The doctor might prescribe a splint to restrict movement.

Medication often helps. Corticosteroids, such as Prednisone, are often recommended. Over the counter anti-inflammatory drugs such as ibuprofen, Aleve and Motrin may relieve some pain.

Blake said surgery usually comes when other remedies do not work and the symptoms have lasted for at least six months.

Blake said that there is no definitive evidence that repetitive movement, such as using a keyboard, leads to the carpal tunnel syndrome, however, he does recommend that people stretch and use good posture at work. Fractures, arthritis and diabetes are considered possible causes.

"The function of the hand is beautiful, " Blake said. "People take their hands for granted."

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