Doctors Apply Technique To Treat Carpal Tunnel Syndrome

Arthoscopic Surgery Lends A Hand

December 23, 1991|By Lorraine Mirabella | Lorraine Mirabella,Staff writer

William Ison used to come home from his electrician's job with aching wrists and hands, then wake up in the middle of the night with no feeling in his fingers. When the pain spread to his neck and his once-agile hands turned clumsy, he suspected poor circulation and went to the doctor.

By the time Ison was referred to Annapolis hand surgeon Dr. Neill S. Cooper Jr., he'd learned he had carpal tunnel syndrome. The occupational disorder is caused by pressure on a nerve that runs through the wrist and controls sensation in all but the little finger.

Each year, thousands of office and assembly-line workers develop the illness from repetitive motion, such as typing. In 1990, cumulative trauma disorders such as carpal tunnel syndrome made up more than half the work-related illnesses in private industry, up from just 18 percent a decade ago.

For years, surgeons have treated the disorder -- which can lead to crippling muscular deterioration and nerve damage -- with splints, medication and, as a last resort, surgery to relieve pressure on the nerve.

But since mid-October, Drs. Cooper andGarrett J. Lynch, another partner in Anne Arundel Orthopedic Surgeons, have been performing a new surgical technique considered a breakthrough in carpel tunnel treatment.

The orthopedic surgeons are the first and only ones locally using arthroscopy, a technique traditionally used in knee, shoulder and hip surgeries. Surgeons make two smallincisions, insert an internal camera and view the surgery on a videomonitor.

The procedure, developed only last year, eliminates the typical long scar on the palm of the hand, reduces post-operative pain and allows for quicker recovery and return to work.

"When we didopen surgery, we always cut skin and muscle fiber," Lynch says. "Thewhole point of all this technology is it's not as invasive and allows you to return to work and to things you enjoy. It's less stressful to the patient. People have a morbid fear of being cut into. This makes them feel better than having a 3-inch incision.

"We think it works better, but it's new," he says. "It will be 10 years before we can say that."

Working as a team since Oct. 18, the surgeons have operated on seven patients, including Ison.

The 40-year-old Pasadenaresident, a Baltimore Gas and Electric Co. construction engineer for18 years, developed the condition by wiring control panels, using twisting, squeezing motions and gripping hand and power tools over extended periods without resting.

Ison has undergone surgery on both wrists. The doctors performed the first with arthroscopy Nov. 15, but because of scheduling conflicts, performed a traditional, open-hand surgery on the second wrist in early December.

In the operations, doctors cut the ligament making up the roof of a "tunnel," which contains the wrist tendons and nerve. Cutting the ligament relieves pressure the swollen tendons place on the nerve, reducing pain, numbness and tingling.

With the new procedure, a surgeon makes two small incisions, inserts a video endoscope that enables him to view the surgeryon a monitor, then inserts knives through that.

Ison, now recuperating, can feel the difference. His right arm has recovered and become stronger faster. His left arm feels much more sore and swollen because of the stitches, he says.

He has begun to write with his righthand but can't yet open a jar or twist a doorknob.

In most cases,patients who undergo the arthroscopic surgery recover enough to use the hand fully within six weeks. They can return to their original jobs any time from three months to one year later. Someone who uses theinjured hand minimally could return to work the week after surgery, Lynch says.

"Others have got very sensitive nerves and more arthritis and can't do that because the tendinitis will be stirred up again," Cooper says.

Ison expects to return to his most recent positionwith BG&E, substation technician, by mid-January. That job places much less strain on his hands than his former electrician job. He says he never could go back to that.

Most distressing to Ison is the knowledge that he could have prevented his injuries with more information about hand and wrist safety.

Cooper and Lynch, staff doctors atAnne Arundel Medical Center who work from four offices including TheArthroscopy & Sports Injury Center, suggest several prevention steps.

They recommend minimizing repetition, keeping the wrist in a neutral position, using the whole hand rather than the thumb and index finger to grip or grasp, resting the hands periodically and reducing speed and force of movement.

"I'm glad that the pain from the nerveis gone," says Ison. "I still have pain, but I can live with what I've got. It's a far cry from what it was."

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