Percutaneous procedures for soft tissue injuries include treatment for trigger finger, a condition in which a tendon becomes entrapped within a tight sheath in the palm, and painfully snaps during routine use of the hand. Release is provided by dividing the stenotic sheath. In traditional surgery, this required an open incision in the palm of the hand. Percutaneous technique allows the surgeon to accomplish the same surgical result without an incision, using a special needle.
Treatment for carpal tunnel syndrome, while not strictly defined as a percutaneous procedure, is somewhat similar. In this condition, the patient experiences pain and numbness in the hand as a result of compression of the median nerve in the carpal tunnel of the wrist. To alleviate this pressure, some hand surgeons utilize an endoscopic technique rather than the traditional open surgery. Small instruments are inserted beneath the skin to identify and release the transverse carpal ligament. The procedure creates more room in the carpal tunnel and relieves nerve compression.
These mini-incision techniques have been shown to provide comparable long-term results to traditional, open surgery and provide a quicker return to activities in the short-term. It also provides a good option for patients who cannot tolerate a large incision in the palm of the hand, such as those who rely on a cane or crutches for ambulation.
Complications, Outcomes and Advanced Procedures
Minimally invasive surgery has been shown to be safe and effective for a number of hand and wrist conditions. However, no surgery is without risk. The surgeries, not unlike their open counterparts, still involve the possibility of nerve or blood vessel injury. According to Dr. Wolfe, the best way to ensure a successful outcome and minimize that risk is to seek care from an orthopaedic surgeon with specialized training and experience in surgery of the hand.
"These procedures are not replacing traditional surgery," he adds. "While they may ultimately prove to result in better and faster recovery, they are not appropriate for everyone. Electing to have minimally-invasive hand or wrist surgery is a patient and surgeon-guided decision."
With the growing interest in, and successful outcomes of minimally invasive surgery, Dr. Wolfe anticipates that more procedures will become available in the future, including-with the development of smaller instrumentation-use of arthroscopy in smaller, tighter joints.
Summary prepared by Nancy Novick • Diagnostic imaging examinations provided by HSS Radiologists
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