A hand surgeon with Baptist Health Orthopedic Care is the first in the Boca Raton area to offer the most advanced, minimally invasive surgery to treat carpal tunnel syndrome. It utilizes live ultrasound visualization and a sophisticated single-use device.
Michael Cohn, M.D., orthopedic hand surgeon with Baptist Health Orthopedic Care in Boca Raton.
Most importantly for the patient, the procedure known as “carpal tunnel release” is done in minutes, often using only local anesthesia, explains Michael Cohn, M.D., orthopedic hand surgeon with Baptist Health Orthopedic Care in Boca Raton who specializes in the surgical and nonsurgical treatment of hand, wrist, elbow and shoulder disorders.
Through a tiny incision that does not require stitches, the procedure has been shown to decrease patients’ pain and reduce their recovery time significantly, compared with standard open and endoscopic carpal tunnel release procedures.
“The procedure is performed through a 4-millimeter incision at the base of the wrist that heals very rapidly and without stitches -- usually within three to five days,” explains Dr. Cohn. “Many patients are getting back to work activities within three to five days after the procedure, and back to sports and exercise activities within a week or so."
Dr. Cohn has been utilizing ultrasound in his clinic daily for over 13 years to diagnose and treat patients with a variety of conditions. He has observed a number of remarkable benefits for his patients since he adopted ultrasound-guided carpal tunnel release over his prior use of primarily endoscopic carpal tunnel release. Many patients can now avoid additional time and costs associated with preoperative testing, EMG/nerve conduction studies, anesthesia, and several postoperative visits, he said.
Carpal tunnel syndrome is an extremely common condition that causes numbness, tingling, and pain in the hand and forearm. It involves one of the major nerves to the hand — the median nerve — which becomes squeezed or compressed as it travels through the wrist.
Dr. Cohn can diagnose most patients with carpal tunnel syndrome during a single office visit by performing an ultrasound examination, rather than requiring the patient to see a neurologist for an electrodiagnostic study, also known as an EMG/nerve conduction study.
“With the live ultrasound-guided approach, I can see and protect all of the nearby vital structures even better as I'm working, compared with the older methods of open and endoscopic release,” said Dr. Cohn. “At the same time, I am utilizing a less invasive approach and faster recovery for my patients in returning to their work and other activities."
The most widely utilized surgery for carpal tunnel syndrome remains "open carpal tunnel release,” a surgery that often uses an approximately three-inch incision in the palm, cutting through layers of tissue that are left undisturbed and untouched with the ultrasound-guided procedure.
The more advanced ultrasound-guided procedure provides a quicker recovery period -- usually days -- compared to weeks or months following open or endoscopic carpal tunnel release.
“No overlying muscles are cut by the small device used, so it's very precise and a very minimal procedure,” said Dr. Cohn. “My patients are often feeling much better than before surgery by their first post-op office visit days later. There’s minimal pain after the procedure, with most patients taking just Tylenol or Ibuprofen the first couple days after the procedure. And they’re getting back to work and exercise much more rapidly, compared to other CTR approaches, in my experience of over 1,500 carpal tunnel releases."
Top Risk Factors for Carpal Tunnel Syndrome
In most cases, the symptoms of carpal tunnel syndrome begin gradually, without a specific injury. As the condition worsens, symptoms may occur more frequently or may persist for longer periods of time.
Nighttime symptoms are very common because many people sleep with their wrists bent, and symptoms may awaken them. During the day, symptoms often occur when holding something for a prolonged period of time with the wrist bent forward or backward, such as when using a phone, driving, or reading a book, according to the American Academy of Orthopaedic Surgeons.
“Many people develop carpal tunnel syndrome based on their sleep habits,” said Dr. Cohn. “We know from research studies that if the wrists are held in a bent position for prolonged periods there's increased pressure on the median nerve.”
Other risk factors for carpal tunnel syndrome may include genetics. This is likely an important factor because the carpal tunnel may be naturally smaller in some people, or there may be anatomic differences that change the amount of space for the nerve — and these traits can run in families.
Hormonal changes during pregnancy can cause swelling that results in pressure on the median nerve. Underlying health conditions than can contribute to carpal tunnel syndrome include diabetes, rheumatoid arthritis, thyroid imbalance, and obesity.
If diagnosed and treated early, the symptoms of carpal tunnel syndrome can often be relieved with nonoperative care. This may consist of wearing a splint or brace while sleeping, which reduces pressure on the median nerve by keeping your wrist straight. Occasionally a cortisone injection may be offered to alleviate symptoms temporarily.
“The patients who require carpal tunnel release are not going to get better fully with nonoperative care,” said Dr. Cohn. “With continued pressure on the median nerve over time, the nerve will gradually accumulate permanent damage which is associated with permanent constant numbness, pain and/or weakness -- unless we do the release before this all occurs.
“There's an estimated 13 million Americans with carpal tunnel syndrome. It’s one of the most common hand conditions. It’s a great advancement that we have this newer procedure to help patients which is simpler and easier.”
