Outpatient Procedure Mends Carpal Tunnel

Endoscopic wrist surgery relieves nerve pressure after noninvasive approaches fail.

For the bulk of her career as an educator, Cindy Forse helped children cope with the difficulties of dyslexia. It was rewarding work that came to an end the moment she and her husband moved to Florida several years ago.

Cindy has regained full use of her hands.

“I came here from Texas, and it was as though no one had ever heard of anything like that before,” Cindy says of a learning program for dyslexics. “So here in Florida, I just taught early elementary schoolers, mostly first-, second- and third-graders.”

Cindy, 63, and her husband recently retired. She now spends a good part of her time gardening and landscaping the couple’s Punta Gorda home. A crippling problem with her hands once made that pastime more of a chore than she wanted.

“I’m one of those people who tolerates problems like that until you just can’t take it anymore, so this went on for about seven or eight years,” Cindy reveals. “It wasn’t so much pain that I was feeling; it was numbness, tingling, swelling and weakness.

“I’d wake up every morning with the tingling and numbness, and it would usually take me about an hour to get my hands awake to where I could do anything with them. So, doing things like opening a jar or making the bed was very difficult for me.

“Sleeping was the worst, though. I had to sleep on my side with my arms totally extended. If I bent them in any way, I’d wake up with no feeling in my hands at all. Even extended, I’d still wake up in the middle of the night with that tingling feeling.

“And then there was the weakness. After a while, my hands became so weak that I couldn’t do a lot of the things that I enjoy, like gardening and working in the yard. My hands never really hurt. They were just very weak.”

Nerve Compression

Irritated, Cindy finally sought help for the problem a couple of years ago. On the advice of her primary care physician, she visited Advanced Orthopedic Center, where she was initially examined by Lee M. James, DO.

Dr. James quickly determined Cindy was suffering from carpal tunnel syndrome, a common condition where compression of the median nerve in the wrist causes numbness and tingling in the hands.

Many believe carpal tunnel syndrome is a disorder that develops mostly in those who work regularly at a computer keyboard. That theory is false, although the flexion caused by typing can exacerbate pressure on the median nerve.

The truth is, anyone in any profession can experience carpal tunnel syndrome. The good news is the problem usually can be alleviated through simple measures such as wearing a splint on the wrist.

At Dr. James’ request, Cindy first tried to alleviate her symptoms with a splint. That alleviated some of the tingling and numbness, but it further limited the use of her hands.

“The splint wasn’t a win-win for me,” Cindy reports. “So, the next thing Dr. James tried was steroid injections in both wrists. Those worked for a while, about a year, but then the tingling and numbness and everything came back.”

Ligament Relief

After her symptoms returned, Cindy went back to Advanced Orthopedic Center. This time she was placed in the care of Sean A. Spence,
a fellowship-trained hand surgeon who determined that Cindy needed surgery.

“When a patient reaches the point where their carpal tunnel is starting to affect their grip strength, their pinch strength, their ability to use their hand, the smart thing to do is to perform surgery and release the carpal tunnel,” Dr. Spence reasons.

“That’s where Cindy was after we’d tried the other treatments, so I recommended the surgery to release what is called the transverse carpal ligament. We perform that surgery through a small incision – about one centimeter – at the base of the wrist.

“Through that incision we feed a small camera into the hand that lets us see the ligament that is placing pressure on the nerve. To alleviate that pressure, we have to relieve the entire transverse carpel ligament while also making sure to protect the nerve.

“This is why a fair amount of experience is required for this surgery because when it’s done correctly and you get a complete release of the transverse carpal ligament, the chances of having to do this again is less than 1 percent.”

The surgery is typically performed on an outpatient basis in a surgery center using a local anesthetic with the patient under light sedation. The procedure takes about 15 minutes, but surgery can be avoided if sufferers seek help for their symptoms early.

“The earlier we treat carpal tunnel syndrome the better, so anyone experiencing consistent numbness and tingling should seek help for it,” Dr. Spence urges. “We can get good results from nonsurgical options, but we have to treat the condition early.”

Cindy waited too long to seek help, which is why she wound up having surgery this past winter. Since the operation, the numbness and tingling have disappeared, and she is slowly regaining full use of both hands.

“I couldn’t be happier with how things turned out,” she lauds. “I can sleep with my hand under my pillow and do my gardening or anything I want. The doctors at Advanced Orthopedic Center did a great job, and it was a true team effort.

“I really appreciate the way they do business, and I gladly recommend them to anyone. In fact, I already have. I recently saw a woman with a splint on her wrist, and I asked her if she had carpal tunnel syndrome. She said, Yes, and I said, Then you need to go to see Dr. James and Dr. Spence at Advanced Orthopedic Center. They’re great.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. mkb
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    • Advanced Orthopedic Center

      Whether you are a professional or collegiate athlete, an active retiree, a "weekend warrior," a high school football star or a hard-working employee anxious to make a difference, the Advanced Orthopedic Center is here to help you feel better a... Read More

    • Lee M. James, DO

      Lee M. James, DO, received his undergraduate degree from the University of South Florida. He earned his medical degree at Nova Southeastern University. Dr. James is board certified in physical medicine and rehabilitation, and pain medicine. He ... Read More

    • Sean A. Spence, MD

      Sean Spence, MD, is an orthopedic surgery specialist who is fellowship-trained in hand and upper extremity surgery. Dr. Spence earned his bachelor’s degree from the University of Florida in 2009 and then spent two years in a post bac... Read More