Patient Education

Endoscopic Carpal Tunnel Release (ECTR) refers to a method of performing carpal tunnel release surgery using an endoscope or an arthroscopic device. For ECTR or any carpal tunnel release surgery while there are many different blades and techniques the primary goal is to release the transverse carpal ligament (TCL) that overlies and compresses the median nerve within the carpal tunnel. It is this compression on the median nerve that leads to the characteristic ‘pins and needles’ paresthesia in the thumb, index, long and ring fingers. The primary benefit of endoscopic releases versus traditional open carpal tunnel release is often perceived to be the smaller incision size. ECTR incisions are commonly less than 1 cm (0.39 in) compared to a 2–4 in (51–100 mm) longitudinal incision with a traditional carpal tunnel release. However, the incision size is not the only factor that differentiates the two methods. The principle behind the endoscopic release is that the Palmar aponeurosis, a thick tough layer of tissue that lines the palm, is not divided with endoscopic methods. In addition, the endoscopic methods offer less dissection and interruption of tissue planes than the open methods because the endoscopic methods do not divide the subcutaneous tissues or the palmar fascia to the same degree as the open method does. Thus, a more rapid recovery is generally touted with ECTR as the normal skin above the TCL is not incised. Surgery, either open or endoscopic is a way to treat Carpal Tunnel Syndrome.

The cubital tunnel release surgery will only be recommended after the different applications of treatments and therapies. The avoidance of repetitive motion will be the first recommendation so that you can prevent the development of carpal tunnel disorder. It could affect your working habits or nature of works which is very hard to consider for the sufferers, especially if the job is the main source of income. Using the right tools and technology will help reduce the pain that the sufferers have been feeling.

Knee arthroscopy has in many cases replaced the classic arthroscopy that was performed in the past. Today knee arthroscopy is commonly performed for treating meniscus injury, reconstruction of the anterior cruciate ligament and for cartilage microfracturing. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging. During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed. Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopaedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.

Tennis elbow is soreness or pain on the outer part of the elbow. It happens when you damage the tendons that connect the muscles of your forearm to your elbow. The pain may spread down your arm to your wrist. If you don’t treat the injury, it may hurt to do simple things like turn a key or open a door. A commonly used surgery for tennis elbow is called a lateral epicondyle release. This surgery takes tension off the extensor tendon. The surgeon begins by making an incision along the arm over the lateral epicondyle. Soft tissues are gently moved aside so the surgeon can see the point where the extensor tendon attaches on the lateral epicondyle. The extensor tendon is then cut where it connects to the lateral epicondyle. The surgeon splits the tendon and takes out any extra scar tissue. Any bone spurs found on the lateral epicondyle are removed. (Bone spurs are pointed bumps that can grow on the surface of the bones.) Some surgeons suture the loose end of the tendon to the nearby fascia tissue. (Fascia tissue covers the muscles and organs throughout your body.) The skin is then stitched together. This surgery can usually be done on an outpatient basis, which means that you don’t have to stay overnight in the hospital. It can be done using a general anesthetic or a regional anesthetic. For surgery on the elbow, you would most likely get an axillary block to numb your arm.

Arthroscopy is commonly used for treatment of various diseases of the shoulder including subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder (adhesive capsulitis), chronic tendonitis and partial tears of the long biceps tendon, SLAP lesions and shoulder instability. Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of camera that allows the doctor to view the site without the full incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.

Open Reduction Internal Fixation (ORIF) involves the implementation of implants to guide the healing process of a bone, as well as the open reduction, or setting, of the bone itself. Open reduction refers to open surgery to set bones, as is necessary for some fractures. Internal fixation refers to fixation of screws and/or plates, intramedullary bone nails (femur, tibia, humerus) to enable or facilitate healing. Rigid fixation prevents micro-motion across lines of fracture to enable healing and prevent infection, which happens when implants such as plates (e.g. dynamic compression plate) are used. Open Reduction Internal Fixation techniques are often used in cases involving serious fractures such as comminuted or displaced fractures or in cases where the bone would otherwise not heal correctly with casting or splinting alone. Risks and complications can include bacterial colonization of the bone, infection, stiffness and loss of range of motion, non-union, mal-union, damage to the muscles, nerve damage and palsy, arthritis, tendonitis, chronic pain associated with plates, screws, and pins, compartment syndrome, deformity, audible popping and snapping, and possible future surgeries to remove the hardware.

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement orthopedic surgery is generally conducted to relieve arthritis pain or fix severe physical joint damage as part of hip fracture treatment. A total hip replacement (total hip arthroplasty) consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most common orthopaedic operation, though patient satisfaction short and long term varies widely.

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage. Shoulder replacement surgery is an option for treatment of severe arthritis of the shoulder joint. Arthritis is a condition that affects the cartilage of the joints. As the cartilage lining wears away, the protective lining between the bones is lost. When this happens, painful bone-on-bone arthritis develops. Severe shoulder arthritis is quite painful, and can cause restriction of motion. While this may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.

Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created by a single hole punch. The surgery is performed arthroscopically. An ACL reconstruction is sometimes referred to, incorrectly, as an ACL repair. A torn anterior cruciate ligament cannot be “repaired”, and must instead be reconstructed with a tissue graft replacement.

The lateral collateral ligament is a thin band of tissue along the outer side of the knee. It joins the thighbone (femur) to the fibula. (The fibula is the small bone of the lower leg that runs down the side of the knee to the ankle.) Like the medial collateral ligament, the lateral collateral ligament’s main job is to keep the knee stable as it moves. Tears to the lateral collateral ligament most often occur from a direct blow to the inside of the knee. This can stretch the ligaments on the outside of the knee too far and may cause them to tear. This type of injury occurs in sports that require a lot of quick stops and turns such as soccer, basketball and skiing or ones where there are violent collisions such as football or hockey. The ligament can also be injured by repeated stress that causes it to lose its normal elasticity. Most knee injuries are to the ligaments that support the knee, not the knee joint itself.

Surgical Treatment for Lateral Collateral Ligament Tears: If the lateral collateral ligament was torn where it attaches to the thighbone (femur) or shinbone (tibia), the surgeon will re-attach the ligament to the bone using large stitches or a metal bone staple. If the tear happened in the middle of the ligament, the surgeon will sew the torn ends together. If the damage was severe and cannot be repaired, your surgeon may reconstruct a tendon by using a graft taken from a tendon of your thigh muscles (quadriceps) or your hamstrings. Lateral knee reconstruction is an open-knee procedure, and is not done arthroscopically. The tendon graft is passed through bone tunnels and fixed to the thighbone and lower leg bone (fibula) using screws or posts or with stitches tied around a post.
Non-surgical Treatment of Lateral Collateral Ligament Tears: Lateral collateral ligament tears do not heal quite as well as medial collateral ligament tears do. Grade 3 lateral collateral ligament tears may require surgery. In some cases, all that is required to complete the healing process is rest, wearing a brace, taking pain relievers such as ibuprofen and having physical therapy. Your doctor may recommend that you wear a lightweight cast or brace that allows your knee to move backward and forward but restricts side-to-side movement. This is usually worn 72 hours. Depending on how well it reduces your pain and swelling, you may be able to start a rehabilitative program in a few days. When the pain and swelling have gone down, you should be able to start exercises to restore strength and normal range of motion to your knee. If you are still having soreness while doing these exercises, proceed slowly to prevent further irritation. It may take anywhere from one to eight weeks to fully recover, depending on the grade of your injury.

The medial collateral ligament (MCL) is a wide, thick band of tissue running down the inner knee from the thighbone (femur) to a point on the shinbone (tibia) about four to six inches from the knee. The MCL’s main function is to prevent the leg from extending too far inward, but it also helps keep the knee stable and allows it to rotate.

Surgical Treatment for Medial Collateral Ligament Tears: A torn medial collateral ligament is rarely treated with surgery. When surgery is done, it is usually done through a small incision on the inside of your knee. It is not done arthroscopically, since this ligament is not inside the knee joint. If the medial collateral ligament has been torn where it attaches to the thighbone (femur) or shinbone (tibia), the surgeon will re-attach the ligament to the bone using large stitches or a metal screw or bone staple. If the tear was in the middle of the ligament, the surgeon will sew the torn ends together.

Non-surgical Treatment of Medial Collateral Ligament Tears: The medial collateral ligament has a good blood supply and usually responds well to non-surgical treatment. Depending on how bad the injury is, it may be enough to rest the knee, wear a brace, take over-the-counter pain relievers such as ibuprofen and have physical therapy. To keep the knee from moving, your doctor may recommend a lightweight cast or brace that allows your knee to move backward and forward but limits side-to-side motion. This usually is recommended for 72 hours. Depending on how well your pain and swelling get better, you may be able to start a rehabilitative program in a few days. Once pain and swelling have gone down, you should be able to start exercises to restore strength and normal range of motion to your knee. If you are still sore while doing exercises, you should proceed slowly to prevent further irritation. It may take a week to eight weeks to completely recover, depending on the seriousness of your injury.

Surgery may be used to treat a rotator cuff disorder if the injury is very severe or if nonsurgical treatment has failed to improve shoulder strength and movement sufficiently. The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.