Endoscopic Approaches to Hand Conditions

For some of the most common hand conditions I encounter, I often treat with innovative scope-assisted, minimal-incision approaches.  Endoscopic carpal tunnel release has been around for 25 years but not every surgeon is comfortable with performing this procedure.  I have a 25-year history of training hundreds of surgeons in this technique and performing these treatments myself.  I had even done revision or redo carpal tunnel releases using the endoscopic technique.  The benefits are well described in a randomized double blinded prespective study that I published over a decade ago in The Journal of Bone & Joint Surgery, our premier journal (*JBJS Trumble, Diao, et al.).  Presently, these surgeries are done under local anesthesia with mild sedation and take 10 to 15 minutes of operating time.
 
Endoscopic cubital tunnel release is a much newer procedure but one I have been performing over the last several years.  My success rate has been very high, upwards of 90% good to excellent results.  Instead of a 10-cm incision, a small 1-inch incision is all that is required.  Again, rehabilitation is greatly reduced using this minimal-incision approach.
 
Arthritis of the base of the thumb is a common affliction particularly in women above a certain age.  I have over a hundred patients that I have performed arthroscopic debridements and cartilage substitution surgery using a bio-engineered material.  Again, I have had excellent results with more than 90% of patients having good to excellent results, and I have made numerous national presentations regarding the use of this technique.
 
Arthritis of the wrist is a relatively common condition, particularly for those people who have been very active in sports or in their occupations.  The traditional treatments require significant alteration of normal anatomy.  My philosophy has been to do the minimum surgery required to improve patient’s function and quality of life.  I have developed an arthroscopic approach for selective debridement and improvement of arthritic wrist joints without sacrificing a lot of normal anatomy, and without removing or fusing the small bones of the wrists. The results have been, on occasion, outstanding.  Although I cannot tout that the success rate approaches 80% or 90%, I think these approaches are definitely worth consideration for patients who want to maintain an active lifestyle and are interested in minimalist approaches in terms of surgery for their problem.  The advantages of wrist arthroscopic procedures are greatly reduced recovery time, smaller incisions, and an accelerated return to high-level function.
 
These are four of the most common conditions that affect the upper limb. Patients are encouraged to schedule a consultation to learn about these advanced techniques.
 
References
* Trumble T, Diao E, Abrams R, Gilbert-Anderson MM: Single-Portal Endoscopic Carpal Tunnel Release Compared with Open Release. J Bone Joint Surg, 84A(7): 1107-15, 2002.

Originally posted on July 12, 2013

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