Surgical Procedures We Perform
Carpal Tunnel Release
Carpal tunnel release is an outpatient procedure performed to relieve pressure on the median nerve and reduce the symptoms of carpal tunnel syndrome. This procedure can help restore muscle strength and dexterity, and is typically performed on patients who have had persistent symptoms that do not respond to conservative treatment methods.
Carpal tunnel release can be performed endoscopically or through an open procedure. Both types offer different advantages to the doctor and patient, and should be considered after a thorough evaluation of the patient’s individual condition. Open carpal tunnel release involves a two inch incision in the middle of the palm and gives the surgeon a better view of the treated area with less risk of accidentally damaging nerve tissue. Endoscopic carpal tunnel release involves two tiny incisions and offers patients less post-operative pain and the ability to return to work more quickly.
Patients can return home the same day, but may need prescription pain medication at first to manage the pain from the procedure. The hand may be kept in a splint for the first few weeks after surgery in order to protect the wrist while it heals. Although patients may continue to experience carpal tunnel symptoms after this procedure, most report that symptoms are significantly reduced after carpal tunnel release.
Percutaneous Rhizotomy
Percutaneous rhizotomy is a procedure that can be an effective form of treatment for chronically painful conditions such as trigeminal neuralgia that have not responded well to medication. Trigeminal neuralgia causes severe, shooting pain in the face due to damage to or compression of the trigeminal nerve. Percutaneous rhizotomy involves using radiofrequency energy to stop the nerve from sending pain signals.
This outpatient procedure generally lasts between one and two hours and begins with the patient being given a short-acting anesthesia. The doctor inserts a needle into the nerve and uses an imaging device to ensure that it is properly positioned. The patient is then awakened to determine the precise portion of the nerve that is the source of the pain. Once that is established, the patient is sedated again and the radiofrequency energy is sent through the needle to destroy a small segment of the nerve.
A common side effect of percutaneous rhizotomy is numbness in an area of the face. This is often temporary, but in some cases it is permanent. Other potential complications include recurring pain, loss of vision, muscle weakness and brain injury. Choosing an experienced surgeon to perform a percutaneous rhizotomy can lower a patient’s risk of developing complications.
Shunt Or Skin Revisions
Normal pressure hydrocephalus (NPH) is a neurological condition common in older adults that causes an enlargement of brain ventricles and stretched nerve tissue in the brain due to an accumulation of cerebrospinal fluid. Patients with NPH usually experience difficulty walking, dementia and bladder control problems.
NPH can usually be treated with the placement of a shunt, which is a device that is implanted to drain the cerebrospinal fluid away from the brain and empties in the abdomen where it is absorbed. The shunt can be a traditional fixed pressure or can be programmable to reach the correct pressure for effectiveness. The shunt is implanted during a relatively simple procedure under general anesthesia.
Tarsal Tunnel Release
Tarsal tunnel syndrome is a condition classified by chronic pain in the ankle, foot and toes caused by abnormal pressure on nerve roots. It is similar to carpal tunnel syndrome in the wrist and hand, but is not as common. The specific cause of tarsal tunnel syndrome is not known, but it can be a result of inflamed tissues around the tibial nerve, injury or other conditions that may affect the area.
The main symptom of tarsal tunnel syndrome is tingling or burning pain while standing or walking that starts in the ankle and spreads to the toes. Pain is usually relieved during rest. Doctors diagnose this condition by trying to induce the tingling sensation when tapping the nerve.
Treatment for tarsal tunnel syndrome depends on the cause of the pain but can include anti-inflammatory medication, orthotics, corticosteroid injections or surgery. Surgery is usually used as a last resort to relieve pressure on the nerve.
Temporal Artery Biopsy
Because of its frequently nonspecific symptoms, temporal arteritis is often difficult to diagnose. A physician suspecting this disorder will perform a complete physical examination, including several blood tests. Other tests which may be used for diagnosis include ultrasound, MRI or PET scan. If tempoal arteritis seems to be a possible diagnosis, a biopsy of the temporal artery may be done to make a definitive diagnosis.
In order to reduce inflammation and relieve the symptoms of temporal arteritis, the doctor usually prescribes corticosteroids. While coricosteroids may produce undesirable side effects, such as weight gain, fluid retention and mood swings, they are an important weapon in fighting the dangers of this condition. It is important that treatment begin as soon as possible after diagnosis to prevent permanent vision loss. Treatment of temporal arteritis may require use of additional medications for up to a year or two in order to make sure the condition is completely eliminated and to reduce the risk of recurrence.
Ulnar Nerve Decompression
Ulnar nerve dysfunction is a condition involving loss of sensation and/or movement in the wrist and hand. It may occur as a result of injury or excessive pressure on the nerve. Symptoms of ulnar nerve dysfunction may include hand weakness, painful, tingling, or burning sensations in the hand, and odd sensations in the fourth or fifth fingers.
To diagnose ulnar nerve dysfunction, the hand and wrist are examined. Additional testing is often done to rule out other possible conditions; these tests may include blood tests, nerve conduction tests, or x-rays.
Treatment for ulnar nerve dysfunction varies depending on its severity. Mild to moderate cases of ulnar nerve dysfunction are usually responsive to splinting, corticosteroid injections, painkillers, and/or physical therapy. Severe cases of ulnar nerve dysfunction that are unresponsive to conservative treatment methods may require surgical decompression. Each patient will receive a customized treatment plan based on their individual condition and medical history.
Ulnar Nerve Transposition
The ulnar nerve of the elbow is susceptible to pinching from several different factors, the most common of which is cubital tunnel syndrome. This disorder is characterized by a numbness in the small (pinky) and ring fingers, particularly when the elbow is flexed. It is important to see a doctor if you experience these symptoms for extended amounts of time, as the neuropathy can cause the muscle to degrade and go to waste, which cannot be reversed. The ulnar nerve may also be compressed at the wrist, in which case a different course of treatment would be necessary.
Wound Revisions
Scar revision is performed to reduce the appearance of scars caused by injury or previous surgery. Scars are by definition permanent, but surgery can narrow, fade and otherwise reduce the appearance of severe or unattractive scarring, which is especially helpful in areas of cosmetic importance such as the face and hands.
There are many surgical methods of scar revision, only some of which may be appropriate for a particular type of scar or its location. These include surgical excision, skin grafts, flap surgery and Z-plasty (repositioning a scar so that it aligns with the face and is less noticeable). The effectiveness of scar reduction depends on a number of factors, including the nature of the injury, your body’s healing mechanism, the size and depth of the wound, how much blood supplies the area and the thickness and color of your skin.
For more information, please call Northwest Spine & Pain Surgical Center at 503-694-8600.