Cheryl Martin (Host): Hand surgery is the second largest orthopedic specialty here in the United States. Dr. Alan Micev, an orthopedic surgeon specializing in hand, wrist and elbow surgery is here to discuss the emerging technologies that will allow patients to get back to normal faster than ever. This is Health Talk with the Valley Health System presented by the Valley Health System.

I'm Cheryl Martin, Dr. Micev, delighted you're here to share the latest options for hand surgery.

Alan Micev, MD, FAAOS: Thank you so much for having me.

Host: So what are some of the emerging technologies in hand surgery?

Alan Micev, MD, FAAOS: Well, one of the newest, biggest additions to hand surgery has been the emergence of ultrasound guidance, in hand surgical procedures that are performed commonly. One of the most common procedures we perform is called a carpal tunnel release. And historically, if your one of your parents or relatives had this surgery, it was a large incision in the palm.

You'd have stitches in place, and the recovery took many months. It was pretty unpleasant. These days, we're doing it under ultrasound guidance with a four millimeter incision and no stitches at all.

Host: And how long does it take for the patient to recover?

Alan Micev, MD, FAAOS: Well, recovery is typically pretty variable, but we actually participated in a multicenter study and found that recovery with ultrasound guidance was substantially faster than the traditional open method. I've had patients personally of mine who have gone back to playing tennis or bowling within a matter of days after surgery, which is substantially faster than the traditional open method. Most patients weren't getting back to most activities for at least two to six weeks.

Host: So how exactly does this technology help them recover faster?

Alan Micev, MD, FAAOS: Well, the beauty of the ultrasound guided carpal tunnel release is that this procedure diminishes the size of the incision. We're now working underneath the skin, and as a result, instead of making a three centimeter incision in the palm, or even a two centimeter incision in the palm, we're making an incision that's about four millimeters in size.

And because we're using ultrasound guidance and we're working underneath the skin, we don't need to cut all the tissue on our way down to releasing the carpal tunnel. We can just open up the carpal tunnel itself. So it's actually a more precise release of the carpal tunnel, which as a result is less tissue cut, faster recovery for the patient.

Host: Now, is this surgery good for all carpal tunnel patients?

Alan Micev, MD, FAAOS: It most likely is good enough for the vast majority, probably 90%. There's really a select few that it's not the ideal technique. One of the best examples I can give is if you've had prior carpal tunnel release in the past, usually our algorithm for treating those patients may be slightly different.

And then the only other patient that probably would not be a great candidate is if we cannot see safely using ultrasound, and that's usually a patient who just has very thick and dense tissue. But these are the minority of patients with carpal tunnel.

Host: So should surgery be the first treatment option, let's say in addition to carpal tunnel, any other hand injuries or arthritic pain?

Alan Micev, MD, FAAOS: No, not necessarily. Surgery is usually the last resort we reserve for most patients. For carpal tunnel usually we recommend starting out with the use of nighttime wrist braces. Most patients with carpal tunnel complain of numbness and tingling and burning in their hands at night. We recommend they use wrist braces while they're sleeping, and that can often alleviate many of their symptoms.

Additionally, we will offer steroid injections to all of our patients in the office. That can also substantially help carpal tunnel symptoms. Same thing with arthritis. We'll usually reserve surgery as a last resort for our patients. There is a rare case with carpal tunnel where we recommend jumping to surgery, and that is if you have severe carpal tunnel disease, that's the patient where their hands are always numb.

In mild carpal tunnel, the numbness usually goes away after you shake the hand out, but in severe cases, the numbness can just stick around permanently. It can lead to atrophy of the muscles of the hand and permanent irreversible nerve damage. When we see that in the office, we recommend bypassing non-operative treatment and going straight to surgery.

Host: Anything else you'd like to add just about these emerging technologies or the ultrasound guided carpal tunnel release?

Alan Micev, MD, FAAOS: Absolutely. You know, traditionally people think about having carpal tunnel release surgery as a trip to the operating room under general anesthesia, losing weeks off of work, and prolonged recovery. These days, the way we're doing these procedures is in a small surgical suite, the patient is completely awake, like going to the dentist so they can drive themselves to and from the procedure. The incision is incredibly small. Usually we let them take the bandage off the next day and cover it with a bandaid. Many of my patients have said that the surgery wasn't even as bad as some paper cuts they've had.

 Ultrasound itself has been around for a long time. People probably are aware of this, but its use in hand surgery is becoming much more popular, and what we found is the use of ultrasound itself can decrease the need for unnecessary testing in a lot of patients as well. Saving them a lot of time and money.

Host: Patients after this surgery do they experience pain in their hand?

Alan Micev, MD, FAAOS: Usually there's some discomfort afterwards, but most patients after surgery describe having minimal to no pain, potentially a mild ache. Nothing that Tylenol or ibuprofen couldn't handle afterwards. And most patients say that after surgery they have a relief of pain because they were having so much burning pain and numbness and tingling with their carpal tunnel beforehand. That usually goes away afterwards, and as a result, most patients feel better.

Host: That's great. Well, Dr. Alan Micev, thanks for sharing your expertise on hand surgery options with us.

Alan Micev, MD, FAAOS: Thanks so much for having me.

Host: For more information, visit ValleyHealthsystemlv.com. Individual results may vary. There are risks associated with any surgical procedure. Talk with your doctor about these risks to find out if hand surgery is right for you.

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 Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatment provided by physicians.