Nano Arthroscopy Offers Minimally Invasive Carpal Tunnel Solution
Learn about the NanoScopic™ extremely minimally invasive carpal tunnel procedure from hand and wrist surgeon Steven S. Shin.
Carpal tunnel syndrome is a very common condition of the wrist1 that can lead to numbness, tingling, and pain in the affected hand. These symptoms are caused when the median nerve—a nerve in your forearm that runs through a narrow space (the carpal tunnel) in your wrist—is compressed, squeezed, or irritated.
People with jobs that require repetitive use of their hand and wrist (such as carpenters, illustrators, and people who type a lot) tend to be at increased risk of this condition. Additionally, people with medical conditions associated with soft-tissue swelling, including diabetes, hypothyroidism, arthritis, and pregnancy, are prone to developing carpal tunnel syndrome. Another type of this condition, traumatic carpal tunnel syndrome, occurs when a wrist fracture causes increased pressure on the nerve.
Depending on the severity of their carpal tunnel syndrome, some people may find it difficult to perform regular activities that require use of their wrist, such as typing, eating, working out and participating in sports, turning doorknobs and handles, playing a musical instrument, and more.
While conservative (nonoperative) treatments such as injections, medications, and wrist braces can often relieve early symptoms, your doctor may recommend surgery to decompress the median nerve as your symptoms progress.
Carpal tunnel syndrome is a condition that can be addressed using Nano arthroscopy, in which your surgeon uses a tiny, high-quality camera at the tip of a thin wirelike device, along with other small instrumentation, to view and treat your condition in a less disruptive way. Because of its small size, Nano arthroscopy can be particularly helpful in very small spaces, such as the wrist.
One type of Nano instrumentation, the NanoScopic™ carpal tunnel release system, provides many patients a solution for carpal tunnel syndrome that can be performed in an office setting, often without general anesthesia.
Here, Steven S. Shin, MD (Los Angeles, CA), discusses his experience using the NanoScopic carpal tunnel release system in his practice and how the system has allowed him to provide exceptional treatment options to his patients.
What are some of the signs and symptoms patients with carpal tunnel syndrome may experience?
The most common symptoms of carpal tunnel syndrome are numbness and tingling in the hand; many patients say this often becomes painful. When the condition is severe, some patients also experience weakness due to muscle atrophy (when the muscle tissue becomes reduced).
How do you determine whether a patient’s carpal tunnel requires surgery?
When patients come to see me about their carpal tunnel syndrome, we discuss their symptoms and (if available) the results of their physical exams and electrodiagnostic studies (electrodiagnostic testing, or EMG, is a test that evaluates nerve and muscle function). If these are consistent with carpal tunnel syndrome and the patient is not responding sufficiently to nonoperative treatment, then they may be a candidate for a carpal tunnel procedure.
In your experience, how long does a NanoScopic carpal tunnel release procedure take?
The NanoScopic carpal tunnel release procedure is an outpatient procedure that can be done in a doctor’s office or procedure room. For me, the procedure typically takes between 3 and 5 minutes, and many of my patients do not require general anesthesia.
What are the advantages of the NanoScopic carpal tunnel release procedure compared to traditional carpal tunnel surgery?
I have found that endoscopic carpal tunnel surgery has definite advantages over traditional open carpal tunnel release surgery, and the NanoScopic carpal tunnel release system is a significant advancement in the world of endoscopic carpal tunnel release surgery.
It is minimally invasive, causes less postoperative tenderness,2 and allows the patient to return to their normal activities faster.2 Also, the incision is small and more cosmetic.
The tiny nature of the camera and the portability of the tablet that shows the camera feed means the procedure can be quickly completed in a procedure room with a small incision. In many cases, it does not require general anesthesia.
Another advantage is that this system uses single-use, sterile-packed, disposable instruments, meaning surgeons use brand-new, sterile instrumentation for each patient (rather than reusable products).
How do you prepare the patient for surgery?
We want to ensure the patient doesn’t have any contraindications, or reasons they would be restricted from undergoing this procedure. Once a patient is medically cleared, prep is quite easy: The patient lies on the operating table with their affected hand on an attached table. Then we prep and drape the wrist to ensure that the area stays sterile before moving forward with the procedure.
What can you share about the patient experience after a NanoScopic carpal tunnel release procedure?
Every patient is different and has a different pain response and definition of recovery. Their postoperative protocols may also differ based on their particular circumstances, wrist strength, and tenderness after surgery.
Compared to traditional surgery, patients can begin the road to recovery and return to their typical activities much faster. Research shows that, even taking factors such as tenderness and strength after surgery into account, patients returned to work weeks faster after Nano arthroscopy compared to traditional carpal tunnel surgery.2,3
Literature and my experience also show that patients experience less postoperative tenderness.2
You can read more about what to expect after this procedure, including another surgeon’s example recovery protocol.
What would you say to a patient considering a NanoScopic carpal release procedure who is afraid of surgery?
I would tell them that the advances in Nano arthroscopy allow this procedure—I would hardly even call it surgery anymore—to be performed very comfortably and safely with little disruption to their daily life.
See your health care provider if you have symptoms of carpal tunnel syndrome that interfere with your day-to-day life or find a doctor who performs Nano arthroscopy procedures.
Surgeon is a paid consultant for Arthrex Inc.
References
- Sevy JO, Varacallo M. Carpal Tunnel Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 5, 2022. https://www.ncbi.nlm.nih.gov/books/NBK448179/
- Brown RA, Gelberman RH, Seiler JG 3rd, et al. Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg Am. 1993;75(9):1265-1275. doi:10.2106/00004623-199309000-00002
- Agee JM, McCarroll HR Jr, Tortosa RD, Berry DA, Szabo RM, Peimer CA. Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg Am. 1992;17(6):987-995. doi:10.1016/s0363- 5023(09)91044-9
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