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Hand and Upper Extremity Archive Questions

Below are Dr. Akabudike’s answers to Hand and Upper Extremity questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.



Now displaying records 1 to 5 of 5.

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Q : 1

03/18/2013
I am considering surgery to relieve carpal tunnel syndrome. I understand the surgery cuts the ligament that surrounds this area. Does the ligament ever grow back together? Some articles I've read seem to imply that it does. What are the risks of having the surgery - will I lose strength or functionality in the wrist, hand, or arm? Is the surgery reversible?

Yes, the transverse carpal ligament which is the roof of the carpal tunnel is transected during surgery. Also, it is correct that you can re-constitute a ligamentous structure in the future that bridges that gap. Pillar pain is one of the well described sequalae that can happen after surgery which is pain in the palm with use and tends to be temporary. Typically, you don't lose strength or function in the wrist, hand or arm because of the surgery. By definition, it's not reversible since the surgery is a transection of a ligament.


Q : 2

11/11/2012
Do you perform the Burton-Pellegrini procedure for tmcj osteoarthritis with subluxation, a modification, or another procedure? How many have you done one way or other? What is a typical recovery?

Yes, I do the Ligament reconstruction and tendon interposition for thumb CMC osteoarthritis. I usually use the palmaris tendon as the graft. If the patient doesn't have one, I use the standard portion of FCR tendon. I have done ~10 over the past year here at the Univ of MD medical center. There is immobilization for the first 3-4 months, less restrictive the further one is from surgery. It can truly take up to a year for patient to feel 100%.


Q : 3

09/05/2012
I've had carpal tunnel syndrome for some time now, years, just recently has become quite severe and surgery was recommended. Should I have both hands done at the same time or separate? And also both of my elbow joints are always very painful, is this an effect of the carpal tunnel syndrome or something unrelated ?

Either option has be performed and has it's advantages and disadvantages. I lean towards separate, staged surgery so you have one hand available for bathroom hygiene and use for daily activities. Carpal tunnel syndrome does not typically cause elbow pain and it is possible that the etiology of the pain is unrelated.


Q : 4

08/11/2012
I had an EMG test that was so bad the doctor said I needed an operation for carpel tunnel syndrome. I am touch typing this question, have had some return of feeling, and I know the problem seems to improve with exercise. I can play video games and don't have much pain. How should I decide if I really need to have an operation?

This is an excellent question. Most surgeons do not base surgical treatment solely on EMG results. Recommendations are usually based after consideration of your history, duration of symptoms, response to splinting, injections etc, physical examination and EMG/NCS studies. The best course would be to evaluated and examined by a hand surgeon. Best, Ngozi Akabudike


Q : 5

07/13/2012
I've had severe CTS that has been worsening for 30 years. Is improvement in hand function and sensation possible after surgical repair?

Longstanding symptomatic carpal tunnel syndrome can be adequately treated surgically with improvement in hand function and sensation. However, due to the long duration of the compression of the nerve, the time it takes to notice improvement will be longer than someone with a shorter duration of symptoms. The other useful tool in understanding the amount of injury to the nerve will be electrodiagnostic studies. They provide an objective measure of the severity of the compression.


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