So, we’re doing your Carpal Tunnel.
Some patients prefer to be sedated and not to be aware of anything with the procedure.
And in that case, we can absolutely do the procedure in the OR. (operating room)
Other patients feel very comfortable, um, we do the procedure in the office.
We simply numb up the area, the same exact procedure we would do in the OR.
Except it’s a little bit less hassle for the patient, they can come in a little bit later.
They don’t have to wait around as long.
It’s also safer in the sense that we don’t require an sedation medications, which can
have side effects.
So I’m getting the numbing medication ready here.
This is not the needle we’re going to use for you,
we’re going to use a little, itty, bitty, skinny needle.
So don’t be worried.
So this is Lidocaine with Epinephrin.
This is like what the dentists use to numb things up.
Kinda makes you really nice and numb, but it also controls the bleeding.
Which is what we need to do.
And allows us to do the procedure here in the office as opposed to an operating room.
In the operating room, we often use a tourniquet
which is like a blood pressure cuff on your arm.
And that can be painful, so a lot of people need some sedation, or sleepy medication,
in order to tolerate that blood pressure cuff.
So we skip the pain part.
A little cleaning solution, kills the germs that live on the skin.
Alright, this is a little stick.
Alright?
Little stick - 1, 2, 3 (inserting needle) You alright?
Getting real numb?
Alright, that’s all there is to it.
That’s all there is to it.
That’s the worst part of today.
So, we will let that numbing medication set up.
(patient) Ok.
And then, we’ll wash up your hand, then we’ll do the procedure.
I think there’s all…, there’s many advantages to doing the procedure here in the office.
One of them is the cost.
The cost of doing the procedure in the office is much less than in the operating room.
With a large operating room staff, anesthesia fees, the additional fees for testing.
Such as getting a pre-operative examination.
Additional fees for equipment, like placing an IV and the IV medications.
Which we don’t use here in the office.
Another advantage is the time savings for the patient.
Not only is the procedure a bit quicker, in terms of not having to wait around as much,
to do the procedure.
In addition, patients don’t have to go visit with their primary care provider to get pre-operative
clearance.
And many patients who are older and very medically infirmed, can have the the procedure done
in the office, because we are not giving those sedation medications.
Alright, and what are we doing for you today?
(patient) You’re doing a surgery of the hand, to ah, to combat the numbness of the
fingers.
You got it.
Carpal Tunnel release surgery.
Alright, everybody agree? (others in room) Yeah.
We’ll go ahead and get started here.
You let me know if anything is uncomfortable or unpleasant.
(patient) Is it ok if I watch?
It is absolutely ok if you watch.
Just don’t lean over into the wound, ok?
Did you eat breakfast today?
(patient) Right, uh-huh.
Yeah, did you have to…, take any, ah, did you
skip any of your medications,
or you were able to take them all?
(patient) No, I took them all.
(patient) I ate my bowl of oatmeal.
(Dr. Adams) Good
The nice thing about doing it here in the office, this way, is that you don’t skip
a meal,
don’t have to go into the OR, don’t have to have the medications that can make you
sleepy
and interfere with higher mathematical skills.
And I’m going to move your nerve out of the way.
Go ahead and wiggle your fingers.
Like your making a fist, see how this is moving in the bottom of the wound?
(patient) What’s that white thing?
That’s the tendon, right here.
(patient) Is that, does that nerve go through the tendon?
No, the nerve sits next to the tendon.
The nerve is right here, and we’re just moving it out of the way.
And there’s your tendon right there.
You see it moving back and forth?
(patient) Ok, now, ah, um, does the nerve, does the tendon pinch the nerve?
No, they all sit under that ligament that we cut.
(patient) Oh
Which is right here.
(patient) uh-huh.
See that right there.
And also right there.
(patient) So how do you get the nerve so that it’s not being pinched anymore?
We cut that ligament that was sitting on top of the nerve.
(patient) Uh-huh.
The ligament springs apart and it leaves more space available for the nerve.
The ligament eventually heals or reconstitutes.
(patient) Will it ever grow back so I’ll have to have it done over again?
Unlikely, sometimes it does grow back, but it usually takes a long time.
(patient) Oh, maybe one of the advantages of being 84 years of age.
The recovery after the carpal tunnel surgery is the same, whether it’s done in the OR
or in the clinic.
The advantage is that you leave the clinic here with a little carpal tunnel dressing
that you take off in one or two days.
Patients, in general, usually say, once they’ve done the carpal tunnel release, I don’t
know why I waited so long?
Many of them have had symptoms that keep them from sleeping well at night,
for months to years.
And in most cases, they’re extremely pleased with the results of the operation and their
level of pain relief.
(patient) Had I known, maybe I would have done it a year earlier.
Alright, that’s all there is.
We’ll put a little dressing on it and away we go.
(patient) Thank you, doctor.
Your welcome.
My pleasure.