4/3/09

Procedure Profile: Carpal Tunnel Release

Carpal tunnel syndrome is fairly common in our population today. It affects mainly older individuals, and is associated with obesity, hypothyroidism, diabetes, pregnancy, family history, rheumatoid arthritis, and wrist shape. In spite of common feelings otherwise, there is very limited relation between work-related repetitive motion and carpal tunnel syndrome. The cause of the syndrome is a compression of the carpal tunnel, causing an impingement on the median nerve of the wrist. This causes pain or numbness in the fingers and thumb. The carpal tunnel release procedure involves reducing this impingement by cutting the carpal ligament. Then, after removing any enlarged tissue surrounding the median nerve, the carpal ligament is lengthened and reattached. The surgery is done on an outpatient basis and usually usually takes about a week of rest before beginning a rehabilitation program to regain muscle control. Results are usually very good, with complete reduction of pain and full mobility retained. This is one of the most common procedures performed by orthopedic surgeons in the United States.

4/1/09

Tendon Transfer Surgery - Ingenuity solves life's most difficult situations

This post is related more directly to the surgery aspect of my blog, as opposed to the most recent posts which had been more concerned with aging and frailty. As mentioned in the title, I would like to cover the procedure of tendon transfer surgery. Just as the name implies, it involves the relocation of a tendon from one muscle to a bone that was previously moved by another muscle. This is practical to do for a quadriplegic patient who has retained movement of the shoulders but has lost control of the arms and hands. This situation is fairly common as the nerves running to the shoulder do not pass through the spinal cord with the rest of the nerves or the lower body. Therefore, an injury even to the highest level of the spinal cord frequently spares the shoulder nerves. Thus, the controllable trapezius muscle is partially removed from the shoulder and reattached lower on the arm or in the hand or thumb to provide either wrist movement, arm movement, or pinching ability. While the possibilities for transplant are limited, the results are a gift for those who receive the surgery. Quality of life goes up dramatically due to increased independence. This procedure is amazing in it's inherent simplicity (just move the attachment point of a muscle to provide a new function) and there is true beauty in its outcome.
 
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