Performed 4 endoscopic carpal tunnel releases (ECTR) and an endoscopic cubital tunnel release (ECubTR) this morning. As well as fixing a finger fracture and performing a LRTI for basilar thumb arthritis.
We’ve come so far so quickly. Many used to think that carpal tunnel syndrome (CTS) was due to traction on the median nerve, and they used to perform the carpal tunnel release from the palm of then hand up to the elbow. Crazy. The ECTRs do so well. Get back quickly with very few complications. Just don’t overdo it or you’ll get some extra pain and swelling you probably don’t want. I’ve been performing ECTRs since 2005; it’s been one of the best changes I’ve made.
When I started practice in 1998 I performed submuscular ulnar nerve transpositions on all of my cubital tunnel syndrome cases. I’ve had that operation performed on both of my elbows, as well. You can’t lift anything heavier than a telephone for 3 months after that. Takes a while to recover. Then I decreased morbidity (pain and problems) by just moving the nerve under the skin. Less pain and limitations. Then a few years ago I started just releasing the ulnar nerve through an open incision. Those patients got back much quicker. In May, 2009 I started performing the ECubTR. Essentially no activity limitations after that, happier patients, same good results with less pain and limitations. Best change I made to my practice in 2009.
The LRTI is another very predictable procedure that I don’t hesitate to recommend in appropriate patients. I always tell my patients it’s going to ‘hurt like heck’ for 3-4 days, but most tell me it doesn’t really hurt that bad. Still, I’d rather have the few patients that do experience pain ready for it, and the ones that don’t can be relieved it’s not as painful as expected. I’ve started closing the LRTI wounds with absorbable stitches so there are no stitches to remove and patients can get back to desk work after a week, if they want.