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Orthopaedic & Rehabilitation Institute
Vein Wrapping Technique Provides Relief for Recurrent Carpal Tunnel Syndrome
For more than 8 million Americans, surgery is a common solution for relief from the pain and discomfort of carpal tunnel syndrome. But for an increasing number of people, the familiar numbness, tingling, weakness or pain returns – sometimes many years after their initial surgery.
Carpal tunnel syndrome is an ailment caused by pressure on the median nerve in the wrist that supplies feeling and movement to parts of the hand. Initial surgery involves cutting the ligament and releasing it from the nerve. While often successful, there are some individuals who report recurrent symptoms due to additional scarring in the affected area.
Dean Sotereanos, MD, Vice Chair of the Department of Orthopedic Surgery at West Penn Allegheny Health System (WPAHS), has seen an increase in the number of patients who are in need of additional care following their initial release surgery. He estimates that 15 to 30 percent of patients who underwent release surgery need a second procedure to remove the scarring in the new tissue that formed over the cut made in the ligament.
Through his extensive research, Dr. Sotereanos and his colleagues have studied alternatives to traditional recurrent carpal tunnel revision surgery using a vein wrapping technique. This type of decompression surgery involves grafting the autologous saphenous vein and wrapping it around the median nerve that leads from the wrist to the hand. The wrap, which acts as a compressive insulator, works effectively to decrease pain and prevent subsequent scarring of the nerves. Based on the successes with saphenous venin grafts, companies have recently begun to market other wrapping products derived from animals for use in humans.
Dr. Sotereanos, considered to be one of the foremost specialists in nerve surgery in the region, has been using the wrapping technique for the past 10 years. In addition to use in recurrent carpal tunnel revisions, Dr. Sotereanos has also seen success using vein wrapping in patients with cubital tunnel syndrome, which is damage to the ulnar nerve in the elbow.
“Our early experience with the autogenous vein graft wrapping technique has shown great promise for the treatment of chronic compressive neuropathy after other procedures have failed,” said Dr. Sotereanos. “The procedure is simple; the donor is readily available; complications are minimal in the donor area; and the graft tissue has good compatibility.”
In addition to the open cut carpal tunnel technique in which an incision is made in the palm and the nerve is visually released, Dr. Sotereanos indicated there are several other surgical methods now being utilized to relieve carpal tunnel syndrome. In mini-open surgery, a smaller opening is made to release the carpal tunnel. Endoscopic techniques eliminate the open cut and use a scope in the wrist to view and release the ligament. All three approaches are viable and are equally effective, according to Dr. Sotereanos.
“The problem with all nerve surgery is the possible scarring necessitating revision,” noted Dr. Sotereanos. “No matter what the second operation, the surgeon should always provide some coverage of the involved nerve to ensure minimal scarring.”
In the past year, Dr. Sotereanos completed about 300 primary carpal tunnel releases at WPAHS. He estimates that he has performed 50 to 60 revisions in the same time period.
“I’ve been seeing many more older patients who had their initial surgery when they were in their 40s to 70s and have recurrent problems,” explained Dr. Sotereanos. “As the baby boom generation ages and more carpal tunnel releases are performed, I expect to see those numbers increase.”
For patients who have had carpal tunnel release surgery in the past, Dr. Sotereanos suggests they keep an eye on how their wrists, hands and fingers feel. If there is pain, tingling, numbness or weakness, or they have problems gripping with the affected hand, then they should consider having their original site checked by a physician with experience and training in treating recurrent carpal tunnel syndrome.
Dr. Sotereanos is especially concerned about patients who may think that their initial carpal tunnel surgery was a failure and that there are no more alternatives to care.
“If someone doesn’t have it checked again, the numbness may never go away and it could become irreparable,” explained Dr. Sotereanos. “Anyone who starts noticing weakness in either hand or the pad of the thumb should be checked immediately. A lot of people think there is nothing they can do about it, but there is a lot we can do to provide significant pain relief and improvement.”