Scar-less Day Surgery for Carpal Tunnel Syndrome
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Carpal tunnel syndrome occurs when the ligaments that support the back of the hand at the base of the wrist become thickened and compress the nerves. Because it begins with slight numbness in the fingers, many people do not notice much, and if there is no pain, it is not much of a problem and is often left untreated. However, the nerve is crushed by the ligaments of the wrist, which are the roof, and is gradually beaten by the tendons that move the fingers, rocking them from the floor.
By the time pain appears and a hospital visit is made, it is not uncommon for nerve damage to be quite advanced.
Once a diagnosis is made, we will perform a nerve conduction velocity test to evaluate the exact extent of nerve damage. Based on the results, we will determine if early surgery is necessary or if a wait-and-see approach is feasible.
Are you under the mistaken impression that you are better once the pain is gone?
When numbness and pain appear and are left untreated, the pain sometimes goes away. However, in most cases, when the pain is gone, it means that the nerve damage has progressed to a further stage. In other words, the nerve has been damaged to the point that it is no longer painful. In this case, if not treated early, muscle weakness may result, making it difficult to hold things. We recommend that you do not leave the numbness in your hand untreated, but have it checked out.
Common Carpal Tunnel Syndrome Treatments
Carpal tunnel syndrome is treated in mild, moderate, and severe cases.
(in Japanese history)1(For minor illnesses)
There are orthotics, extracorporeal shock wave therapy (shock wave), heat therapy, acupuncture, injection therapy, and drug therapy using compresses and medications. Preference is given to treatments that are as simple and painless as possible, but if pain cannot be relieved, injections are often used. Injections use steroids, but the purpose is to reduce swelling of the nerves and surrounding tissues.
Recently, vasodilator therapy can be used to reduce pain caused by moyamoya or inflammatory blood vessels. Inflammatory blood vessels increase around damaged ligaments and nerves as the disease progresses and cause symptoms. This is a new treatment option that may avoid surgery.
(in Japanese history)2) Moderate or higher
If conservative treatment is unsuccessful, surgery is indicated. It is indicated when nerve compression or swelling is found on echo and a nerve conduction velocity test shows moderate or greater impairment. Surgical therapy is usually performed through an incision in the palm of the hand to reach the ligament and release the compression of the nerve by cutting the ligament and opening the tunnel. Surgery performed endoscopically by a hand surgeon is becoming more common,4The wound can be as small as 1.5 mm. There are two methods: a single or double entry site.
(in Japanese history)3(In case of severe disease)
In addition to the carpal tunnel release procedure described above, a tendon transfer procedure is performed to repair muscle weakness in the thumb and reconstruct finger movement.
Conservative therapies, such as injections, had disadvantages such as primary effectiveness, frequent recurrence, and lack of efficacy in advanced cases. In addition, surgery involves an incision (open method), which causes pain in the delicate palms and makes life difficult.
Surgery without cutting" bridging the gap between injection and surgery (a new technique that compensates for the shortcomings of conventional surgical treatment)
Surgery that requires incision is avoided by patients with advanced disease, and many of them do not undergo surgery at the appropriate time, resulting in worsening of their disease. Once a nerve is damaged, it is difficult for it to recover, so the timing of surgery is very important.
The "no-cut" surgery, originally developed to eliminate the disadvantages of incisional surgery, is less invasive and less painful, and can be considered an extension of injection therapy. This makes it easier to choose the right surgery at the right time, without being shunned. As a more advanced concept, it can also be introduced as a preventive treatment before the disease worsens.
The surgery is also suitable for patients who are on anticoagulation therapy due to complications, etc., as it is a surgery with minimal blood loss. Dialysis patients who have a shunt can also be operated on without a blood bandage, so there is no need to worry about the shunt breaking.
By creating a new treatment concept that bridges the gap between injections and surgery, we hope to help reduce the number of patients with carpal tunnel syndrome who are unaware of the progression of their condition until it is too late. The "no-cut" procedure is a new surgical technique that bridges the gap between injections and conventional surgery.
- day trip
- Less pain
- Leaves no scars
- Less bleeding.
- Low risk of infection
- You can take a bath from that day
- You can use your fingers from day one.
- No need for postoperative disinfection visits
- Can be treated before it gets worse.
- Safe for monitoring by echo
- In the case of the ami-decoration method, the ligaments can be preserved.
Characteristics of surgery for carpal tunnel syndrome without cutting
Why can surgery be performed without cutting?
The "no-cut" surgery is our clinic's unique minimally invasive surgery that uses echo to improve the condition of the target tissue through an incision using only a very small device. The use of echo allows us to target tissues in the body that could not be done before without cutting.
Traditionally, small incision surgery, in which an incision is made, and4The only surgery I could perform was an endoscopic procedure using a 3.5 mm thick endoscope. We have developed our own "no-cut" carpal tunnel syndrome surgery by referring to the preoperative endoscopic procedure using an echo to examine the nerve and the procedure using a special device (this special device has not been approved by the Japanese government and is not available in Japan at the time of this writing) that we had performed in our clinical experience overseas. This is our clinic's original "no cut" surgery for carpal tunnel syndrome.
That is, without making an incision, using a needle inserted percutaneously or a thin special knife while viewing high-definition echoes, a ligament can be loosened to take pressure off the nerve (the Ami-Dori method) or a tunnel can be opened through a secure incision (the Hook knife method).2The two methods are performed. Surgery for carpal tunnel syndrome using echo has been performed overseas, but not often in Japan. Although technically difficult in some respects, orthopedic surgery using echo as a guide has hardly been introduced yet.
As a pioneer clinic in Japan that introduced this technique early on, we have evolved a method that is more delicate and precise than any other clinic, reducing the risk of inadequate nerve decompression and neurovascular damage, and improving safety and certainty.
The clinic hopes to serve patients as a local clinic that can provide state-of-the-art treatment by physicians with clinical experience abroad.
The size of the wound is the same as an injection and can be wet from the day of surgery.
To be performed only by manipulation with a needle or a thin special knife,Wound size is the same as injectionsthe ... word (i.e. "the L word" = "love")The scar is almost non-existent at the
Carpal tunnel syndrome is a common disease in middle-aged and older women. Since they run a household every day and often use water for cooking and other purposes, they can use water from the same day,Return to daily life immediately.The "no-cut" surgery seems to be a good indication.
(Minimally invasive surgery, but some pain and swelling may appear at the base of the palm due to manipulation of the ligament. To repair the tissue and reduce pain due to inflammation1~ (after a number N)2It will take about 3 months to complete the surgery, so take it easy as much as possible and do not do any strenuous or unnecessary labor or work after the surgery.1~ (after a number N)2Avoid for a period of months.)
Surgery without cutting is recommended for
Since the disease occurs in middle-aged and older women and those in their prime working years, this treatment is beneficial for these individuals.
- (1) Housewives who often work with water
- (2) Those who do not want to leave scars on their palms.
- (iii) Those who are sensitive to pain
- (4) Those taking anticoagulants or other medications with a history of
- (5) Those with a shunt for dialysis
- 6) Those who want to prevent disease before it gets worse.
- (7) Those who play sports that require the use of their hands
- (8) Those who cannot take time off work
- (ix) Those who are advised to have surgery but do not want to have an incision.
- 10) Those who cannot afford general anesthesia or hospitalization.
- (11) Musicians, musicians, and others who often use their hands
Ultra-high definition echoes are used to ensure safety.
To confirm the position and orientation of the needles and hook knives used, we use Canon high-definition echoes, which are known for their image resolution, rather than the standard echoes used in regular orthopedic surgery. The standard probe used in orthopedic practice18Mhz high-frequency probeIn addition to the24MHz ultra high frequency probecan be used.0.1With a resolution of mmBecause of,The images are more subtle than those of normal echoes, allowing for a safer and more reliable surgical procedure.The 24Mhz ultra-high definition probe has only been introduced at the university hospital level and is available nationwide.It is one of the few medical institutions using the same probe.
Standard resolution echo commonly used in orthopedics
Safe and best treatment by a specialist certified by the Society of Hand Surgeons
The surgical operation is performed using only a needle, without incision, and requires reliable knowledge and skill. Among the plastic surgery specialists in our clinic,Board-certified hand surgeon with expertise in hand surgeryThe treatment will be performed by a specialist who has clinical experience both in Japan and abroad. Our specialists, who have clinical experience both in Japan and abroad, provide safe, up-to-date, and currently best treatment methods with minimal complications.
Difference between "no-cut" surgery and "cut" surgical treatment (open and endoscopic methods)
When incisions are made, the wound continues to hurt, "What is known as "Pillar Pain".occurs at a certain rate. Once this occurs, it is a complication that is intractable and significantly interferes with life after surgery. In the incision method, the skin and deeper tissues must be damaged before reaching the transverse carpal ligament to be dissected, in the following order: skin, subcutaneous tissue, subcutaneous fat, palmar tendon membrane, and transverse carpal ligament. In addition, there is a small branch of the median nerve, the palmar cutaneous branch, which is sometimes cut without the patient's knowledge. It is said that one of the causes of "Pillar Pain" is damage to this invisible "cutaneous palmar branch.
Endoscopic procedures are also performed at a few other institutions. Endoscopic procedures require larger wounds (sutures are required) and more instruments to be inserted, which may result in bleeding, hematoma, infection, swelling, edema, anesthesia and resulting drug allergy, risk of neurovascular damage, and pain,CRPSRisks such as the following are slightly increased.
There are disadvantages such as increased operative time due to the complexity of the procedure, increased time spent using tourniquets to prevent bleeding, a tendency to have arm pain, the need for wound care and suture removal, and the inability to work with water. In addition, because of the large size of the insert, nerve crush may occur in cases of severe carpal tunnel syndrome with high compression.
The biggest problem with the endoscopic method is the high possibility of nerve damage in unseen areas because it is viewed with an optical camera.
Another problem is that endoscopes have a narrow field of view and the nerve and ligament look very similar. Endoscopic surgery has not yet become a mainstream procedure because a nerve-assisting procedure cannot be performed if the nerve is damaged.
Our clinic has developed our own "no incision" surgery to improve the shortcomings of the current surgical procedures. Unlike incisional surgery, the first feature of this technique is that it does not require an incision.Less painThe most important thing to remember is that the surgery can be done on a day trip and leaves no scars. Of course, the procedure can be done on a day trip, leaving no scars, and allowing the patient to take a bath on the same day.Less risk of infection., ,Little bleeding.The main advantage is that the location of nerves, ligaments, and blood vessels can be determined before the surgery. The greatest advantage is that the location of nerves, ligaments, and blood vessels can be ascertained before surgery,Highly safeThis is to say. Even with incisional surgery, the nerve is not visible as the incision is made, and if one is not careful, the scalpel can cut a nerve branch. In endoscopic surgery, nothing can be seen until the optical camera enters, and even if it can be seen, the field of view is narrow, so there is a fear of nerve damage to operate outside the field of view. The "no incision" surgery is considered to be the ultimate in safety, as it does not involve any incision and yet does not damage the neurovasculature.
Our clinic has developed our own "no incision" surgery to improve the shortcomings of the current surgical procedures. Unlike incisional surgery, the first feature of this technique is that it does not require an incision.Less painThe most important thing to remember is that the surgery can be done on a day trip and leaves no scars. Of course, the procedure can be done on a day trip, leaving no scars, and allowing the patient to take a bath on the same day.Less risk of infection., ,Little bleeding.The main advantage is that the location of nerves, ligaments, and blood vessels can be determined before the surgery. The greatest advantage is that the location of nerves, ligaments, and blood vessels can be ascertained before surgery,Highly safeThis is to say. Even with incisional surgery, the nerve is not visible as the incision is made, and if one is not careful, the scalpel can cut a nerve branch. In endoscopic surgery, nothing can be seen until the optical camera enters, and even if it can be seen, the field of view is narrow, so there is a fear of nerve damage to operate outside the field of view. The "no incision" surgery is considered to be the ultimate in safety, as it does not involve any incision and yet does not damage the neurovasculature.
Advantages of surgery for carpal tunnel syndrome without cutting
Downward risk | Advantages |
|---|---|
Hemorrhage/hematoma point | day trip |
infection | Less pain |
Swelling, edema | Less bleeding. |
Anesthesia solution volume | Less operating time |
drug allergy | Short time to apply a painful tourniquet |
neurovascular injury | No postoperative hospital visits required |
pain | No stitches required |
Surgical wound induration, keloids | Leaves no scarring |
range of motion limitation | Bathing is possible on the day of surgery |
CRPS (postoperative pain of unknown origin) | Less likely to have intractable postoperative Pillar Pain |
Avoid the potential dangers of endoscopic methods. (No need to insert a thick endoscopic camera and endoscopic tube into the narrow carpal tunnel and less chance of nerve crush) | |
High-definition echocardiography is used to confirm the placement of nerves and blood vessels, etc., prior to surgery, thus ensuring safety. | |
In the case of the "Ami-Decoration Method," the ligaments can be preserved. |
Practical techniques for "no-cut" surgery
All "non-surgical" carpal tunnel syndrome surgeries are performed as day cases under local anesthesia.
(i)knitting technique(How to loosen ligaments)
(2)hook-knife method(complete dissection of the ligament)
The clinic uses two methods.
(*Surgery for carpal tunnel syndrome that does not involve cutting,Self-funded [not covered by insurance(It will be)
(1) "Ami-Decoration Method This method loosens ligaments by drilling numerous holes in the ligaments that are pressing on the nerves like an origami ami-dori. Since the ligament is not completely removed, the structure of the hand can be preserved. This is a revolutionary new concept of hybrid surgery that can remove nerve compression and preserve the ligament. Another advantage is that it is somewhat less painful than other techniques. However, due to the delicate nature of the procedure, it takes longer than other techniques, about 1 hour and 30 minutes. Although it can be applied to any case, it is more suitable for those who use their hands well and want to preserve the ligaments. This method is unique to our clinic, but similar procedures are performed overseas (in Europe and the United States). Our clinic was one of the first to adopt this method and is the first in Japan to offer its advantages.
(2) "Hook knife method." A knife with a small hook is inserted under the ligament while viewing the echo, and the ligament is completely separated. Our method is characterized by a smaller wound than the endoscopic procedures commonly used in carpal tunnel syndrome surgery. Since the ligaments are securely detached, this method is best suited for patients with relatively severe conditions and the middle-aged and elderly.
Surgical procedures for carpal tunnel syndrome without cutting (1)
~Miami Decorating Method
Surgical procedures for carpal tunnel syndrome without cutting (2)
~ Hook knife method
Are there any disadvantages?
The hook knife and fistula methods, which are non-invasive surgeries, require specialized knowledge in terms of echo manipulation and its reading techniques. In addition, bleeding, postoperative wound pain, and scarring are less likely than with other techniques because there are no wounds.
However, since the compression of the median nerve cannot be released without damaging the transverse carpometacarpal ligament ligament that is compressing the nerve, postoperative1~ (after a number N)2It is necessary to perform activities of daily living that do not strain the same ligament for a month. It is advisable to avoid activities that require force, such as holding the hand or gripping it tightly.
In addition, because any surgery or procedure is invasive to the body, there is a small risk of complications. Specifically, there are the following risks: (1) allergies due to drugs; (2) complications due to swelling, bleeding, or hematoma; (3) infection; (4) nerve or blood vessel damage; (5) pain or resulting movement disorders; (6) thrombosis or embolism; (7) skin scars, keloids, or wound pain; (8) joint contracture or joint instability (when joints are manipulated); (9) other complications (CRPS) and other unforeseen complications (e.g., problems not only in the affected area but in other parts of the body as well). Since the future can be unpredictable, we will take the best possible measures (administration of drugs, additional surgical procedures, additional treatment, resuscitation, emergency medical care, etc.) depending on the situation. In case of emergency, we may perform the surgery without your consent, but we ask that you understand this before accepting the surgery.
About the cost of treatment
Surgery for carpal tunnel syndrome without incision is not covered by insurance. The cost of treatment is as follows
(1) Ami-decoration method: 230,000suffix for names of swords, armour, musical instruments, etc.(Excluding tax) (253,000 yen including tax)
(2) Hook knife method: 170,000suffix for names of swords, armour, musical instruments, etc.(Excluding tax) (187,000 yen including tax)
(Surgical fees include all anesthesia costs, pre- and postoperative medications, surgical drugs, and surgical technique fees.)
At our clinic, we offer non-surgical procedures at our own expense. Although we have introduced this treatment in order to reduce the pain and burden of surgery on our patients, there are some advanced and sophisticated medical treatments that are not fully covered by the current insurance system in Japan. We explain to patients that they should choose this treatment with the understanding that the current Japanese insurance system limits the quality and content of treatment that can be provided.
[On the cost of self-funded treatment.
Self-funded treatment not covered by insurance may not be covered by life insurance or accident insurance benefits. In addition, benefits from workers' compensation insurance, liability insurance, and various public subsidies are also not available.
However, since it is a medical expense, it is deductible.
For Patients Considering Surgery
Due to the magic of the word "surgery," there are many cases in which the appropriate treatment is not given at the right time, the disease progresses, and surgery is chosen only after the nerve cells have become irreversible. We have devised this non-surgical procedure in the hope that if we can minimize the pain and fear as much as possible, the patient will be able to undergo surgery at an earlier stage, recover well, and return to his or her life.
The "no-cut" carpal tunnel syndrome surgery is a unique technique developed at our clinic. As a pioneer clinic in Japan that introduced this technique early on, we have evolved a delicate and precise method that is not available at other clinics, reducing the risk of inadequate nerve decompression and neurovascular damage, as well as safety and certainty.
When patients are asked to choose whether to receive treatment covered by insurance or at their own expense, we explain the advantages and disadvantages of these treatments to them and let them make their own choice. We will then do our best to provide the treatment that the patient chooses. We believe that a relationship of trust with our patients is of utmost importance. We cannot provide treatment without mutual trust. Please feel free to contact us if you have any questions.
If you have any concerns, please contact the doctor until you are satisfied. We will explain as carefully as possible so that you can enter into treatment with conviction.
Responsible for writing Orthopedic Surgeon, Hand Surgery Specialist/Instructor
Yuki Toya
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