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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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  • Doctor Henry was awesome! And Luis was very helpful and nice! - 03/20/17
  • Great staff and speedy process! - 04/14/17
  • 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
  • Staff is always friendly and helpful. I will definitely recommend this office. Dr. Henry is a very skilled surgeon and went out of his way to make sure I understood my procedure and the rehabilitation process. - 03/24/17
  • always outstanding service! - 04/12/17
  • very helpful staff - 01/16/17
  • Everyone was kind and efficient. All things were clearly explained to me and I felt confident in doing my dressings. - 03/03/17
  • I feel very confident in Dr Henry and the direction I am headed. - 03/10/17
  • Dr Henry is a wonderful Dr. and I would highly recommend to others - 02/07/17
  • Great Appoitnment - 05/11/17
  • Very professional - 03/30/17
  • The doctor was very informative and provided me with a solution quickly and I really appreciate that in this day and age. This is an awesome institution. - 03/02/17
  • Great Appoitnment - 05/11/17
  • Very knowledgeable about the possible procedures the could be preformed! Dr. Henry is a very honest person and I appreciate that in a man more than anything. He gave me truth and not what I wanted to hear! Thanks - 04/04/17
  • Luis was great as well. - 01/04/17
  • great service nice folks glad I came to this office doctor was very cool - 03/23/17
  • Thank you! - 03/08/17
  • Great staff, Great Doctor, Great surgery, recovery, and follow up. Thank you for the time and attention with helping me through the entire process. I felt very comfortable and safe with the entire process. - 02/10/17
  • everything HAS BEEN GREAT AND HEALING WELL WITH ALMOST FULL MOTION IN LESS THAN 5 WEEKS. tHANKS dr hENRY - 03/03/17
  • thank you, you all were very helpful - 03/03/17
  • thank you - 02/09/17
  • FIRST CLASS!!!!!!!!!! - 03/03/17
  • excellent! dr & staff! - 06/14/17
  • We have had the best experience here. The staff has always accommodated us and since Tyler is only 10, they always go out of their way to make sure we are comfortable. I have and will continue to recommend Dr. Henry and his staff to anyone I know. Thanks! - 02/28/17
  • Dr. Henry did an excellent job on my grandmothers wrist. Staff is always very friendly and helpful. - 03/02/17
  • The entire team at the Hand and Wrist Center is outstanding. They made the recovery so smooth and comforting from the courteous receptionists, excellent occupational therapist, attentive medical assistants, and brilliant doctor. Thank you! - 03/31/17
  • Very happy I came here for the surgery, etc. - 06/09/17
  • joel was also my assistant but everything was great - 03/07/17
  • All the staff and Doctor Henry were great! - 05/01/17
  • some of the most friendly staff and the doctor always explained the information in a manner in which I could understand which always made it very helpful. will definitely recommend this location to family and friends. - 05/31/17
  • Had a wonderful experience overall. Breaking my arm was tough but the staff here was always very, kind and helpful. Especially Dr. Henry, Mary, Karen, Luis, Joel, Teresa and David. I'll miss them all but hopeful won't have to see them any time soon :)Thank you! - 05/04/17
  • This was my last visit and I'll miss y'all. - 03/29/17
  • :) - 05/11/17
  • all excellent care - 07/12/17
  • :) - 06/01/17
  • everything HAS BEEN GREAT AND HEALING WELL WITH ALMOST FULL MOTION IN LESS THAN 5 WEEKS. tHANKS dr hENRY - 03/03/17
  • Great work. - 02/03/17
  • The staffs here was GREAT!!!! - 06/21/17
  • Dr. Henry and Mary in PT helped me get my dominant arm back in working order. - 04/18/17
  • FIRST CLASS!!!!!!!!!! - 03/03/17
  • I have enjoyed this facility and Dr. Henry has been more than helplful. All questions answered, as well as answers I didn't even know I had! The staff is always helpful. - 03/03/17
  • great job! - 03/20/17
  • I have loved coming here and felt very welcomed by everyone! Thank you so much for all you do! - 03/10/17
  • Fabulous I will be recommending to everyone I know that can benefit from the services provided. - 03/14/17
  • Love the Doctor and his staff. - 02/08/17
  • very good team work, best clinic - 06/21/17
  • Thank you for the hard work and excellent care. If ever I need this type of care again I will be knocking on your door. I've already recommended your services to others. Thanks Again! - 03/07/17
  • Really appreciate the education and insight related to my wrist and future athletic training - 05/31/17
  • very impressed with the whole experience. - 02/28/17
  • very good at explaining how I should take care of my thumbs and always answered any question I had regarding my health issue I was very pleased with my visit and the care I got at both visits - 03/07/17
  • I gained full confidence in Dr. Henry and his staff as I progressed through my recovery. - 03/28/17
  • Awesome experience. Luis rocks! - 04/06/17
  • Great staff. - 05/02/17
  • Dr. Henry gave me my wrist back!!! Thank you Dr. Henry!!! - 07/10/17
  • Staff was very courteous and helpful. Dr. was very informative and easy to understand. - 03/27/17
  • thank you for helping me - 02/03/17
  • thank you for all you have done! I recommend you foranyone that is having any problems via hand wrist. Amazing surgon and doctor!!! - 02/01/17
  • I have enjoyed this facility and Dr. Henry has been more than helplful. All questions answered, as well as answers I didn't even know I had! The staff is always helpful. - 03/03/17










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