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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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  • thank you - 10/16/17
  • every thing was really great - 10/19/17
  • every body was excelent - 01/09/18
  • With the severity of my injury I am amazed at how functional my wrist is with the amazing team work shown at the office. From the very start the service and care have been outstanding!! I can't thank everyone enough! - 02/23/18
  • Great Doctor and staff. Luis is a wonderful asset to the staff - 12/18/17
  • The doctor and staff are the best I have ever had. Very professionalism at its best. - 11/15/17
  • love the circus de sole dvd. everything was amazing. rehab was the best too. - 02/23/18
  • Great job your staff is the best,thank you &GOD Bless all of you! - 06/15/18
  • Thank you for sewing me back together and guiding me through my recovery!!! - 05/15/18
  • Very happy I came here for the surgery, etc. - 06/09/17
  • best place for treatment of hand and wrist problems. Dr. Henry was recommended to me by a friend who is a medical care professional. - 10/06/17
  • Dr. Henry gave me my wrist back!!! Thank you Dr. Henry!!! - 07/10/17
  • the whole group was very good, I had an excellent experience. - 11/09/17
  • The staff is nice and everyone is up on the treatment. I feel confident that I am getting the best care and am glad I came here. - 10/30/17
  • Dr. Henry and his staff are phenomenal. Dr. Henry has a gift for not only treating health issues extremely effectively, but he is extremely thorough and very efficient at communication and explaining everything he is doing and all of clearly outlining your options for future procedures. - 05/11/18
  • all excellent care - 07/12/17
  • very helpful. staff was very helpful and outstanding. Dr. Henry explained everything to me - 06/19/18
  • dr henry does an excellent job of explaining the problem and solution, seems extremely competent - 02/07/18
  • Very nice staff and surgeon. Thumb looks good now after surgery, hopefully thumb continues to heal and stays healed. Thank you - 01/30/18
  • Dr. Mark Henry is a true healer; the finest most competent doctor I've ever encountered. I am forever grateful to Dr. Henry and the entire staff for saving my finger and facilitating my complete recovery with grace and seriousness of intent. Thank you. - 01/10/18
  • you were very good, thank you very much - 05/17/18
  • I appreciate the expertise and experience of Dr. Henry!!! I know I had the BEST hand surgeon!!! - 05/02/18
  • great doctor - 05/23/18
  • MD was very thorough and spent a good amount of time with the patient (me). MD had good bedside manners which you do not see from a lot of doctors nowadays. He also made sure everything was understood and that I was given a chance to ask questions or address any concerns I had. Everyone was courteous and professional. Thank you for making mu visit a pleasant one. - 05/02/18
  • The staffs here was GREAT!!!! - 06/21/17
  • Dr. Henry and his staff are amazing! I was able to get an urgent new patient appointment immediately with surgery that same afternoon. Dr. Henry does an excellent and thorough job explaining my injury and the healing process. Very impressed with his plan of early mobility and physical therapy, which helped restore my function back to normal within 8 weeks of surgery. I would 100% recommend Dr. Henry and his staff! Very pleased and grateful for his help. - 03/23/18
  • Dr. Henry was very informative about the treatment and staff was pleasant. - 01/11/18
  • excellent! dr & staff! - 06/14/17
  • very confortable,Dr. Henrry very professional and very friendly staff - 12/05/17
  • Very efficient practice - 10/19/17
  • outstanding knowledge and gets you into the hospital if needed the same. - 02/09/18
  • :) - 06/01/17
  • an experience beyond expectation - 10/06/17
  • Dr. Henry is a tremendous doctor! - 05/22/18
  • The staff and the Dr. are very helpful and understanding .I have not yet seen a better staff like this office . I will recommend any one here . - 11/06/17
  • I am really happy with my experience. I always knew what was going on and over time got to know the staff based on how many times I've been here. Most importantly, I feel I got the right treatment for my injury. - 10/19/17
  • I couldn't be more pleased with the level of service I received while in Dr. Henry's care. The level of detail in which my injury was explained and resolved, and the level of competency that was displayed throughout the healing was truly outstanding. - 01/30/18
  • Outstanding service and results - 10/30/17
  • Dr. Henry was able to salvage my hand to make it usable again. I have already sent my Father here and he no longer has any pain in his wrist. - 11/13/17
  • I was very impressed with how I was treated by the doctor as well as the Medical assistant. All my questioned were answered and I was treated with care and respect. Luis was Awesome! Doctor Henry was very informative. I will recommend him to friends and family - 06/09/17
  • Thank you for repairing my injury and being kind in the process. - 01/10/18
  • no complaints hand is coming along very well - 11/06/17
  • very good team work, best clinic - 06/21/17










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