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One person out of seven will suffer from carpal tunnel syndrome and/or trigger finger.

This person will need surgery, usually on both hands and/or several fingers.

1 person out of 7 will suffer from carpal tunnel syndrome, and trigger fingers.

 This person will need surgery, usually on both hands and several fingers.

Treatment

Musculoskeletal sonography (or echography) has dramatically expanded among medical specialities for diagnostic and interventional purposes due to its affordability, portability and availability. High-frequency sonography can now be used to guide the surgical release of trigger finger and carpal tunnel. Spirecut’s patented Sono-Instruments allow percutaneous release under sonography in adult patients. The operation is usually done under local anaesthesia, in a day clinic or outpatient facility, the morbidity is minimal, and the patient can immediately resume all activities. The Sono-Instruments® are an improvement of simple needles used by surgeons and radiologists to treat various conditions under sonography (commonly referred to as “needling” procedures). Sono-Instruments provide an adapted design to facilitate the introduction and safe release of the thickened tissue and allow easy perioperative sonographic tracking. Good visualization under sonography renders the surgery safe to prevent iatrogenic injury of neighboring anatomical structures. There are two sizes, the smaller for the fingers and thumb, the bigger for the carpal tunnel.

What is carpal tunnel syndrome?

Are you suffering from carpal tunnel syndrome? You are not alone! It is a frequent disease, affecting one person in ten. Carpal tunnel syndrome is frequent in women between 40-60 years of age but may also be seen in men and younger or older age groups. Diabetic patients are particularly affected. Carpal tunnel syndrome occurs during pregnancy and usually disappears spontaneously after delivery.

The carpal tunnel is a narrow osteo-fibrous passageway in the wrist containing nine flexor tendons and the median nerve. Under overuse conditions (repetitive hand activities), the tissue surrounding the flexor tendons thickens, causing a mechanical compression on the median nerve, resulting in pain, numbness, and tingling in the hand and arm, particularly at night – this is the carpal tunnel syndrome. The disease is frequently bilateral (affecting both hands). Sometimes there is another cause of nerve compression, like a deep ganglion or a bony problem.

Carpal tunnel syndrome is quite painful, prevents sleep at night, and tends to aggravate over time, causing long-term irreversible sensory and motor nerve damage, so early diagnosis and treatment are essential. The diagnosis is usually done by nerve conduction studies and electromyography, sometimes by sonography, or both.

In early cases, non-operative treatment is advised, particularly wearing a night splint, keeping the wrist in a neutral position, and/or performing a corticosteroid infiltration of the carpal tunnel. Nerve gliding exercises may also help. Most carpal tunnel syndromes need, over time, surgical decompression to give more room to the nerve. The classical operation is open surgery with a section of the transverse carpal ligament, enlarging the tunnel. The incision is 4-5cm long. After the procedure, the night pain usually quickly disappears, but the surgical wound healing takes time, preventing an early return to daily activities and work. Many patients also complain of a transient decrease of their grip strength and pain at the base of the wrist, called “pilar pain”, lasting months or sometimes years. Other complications are sometimes seen, some quite severe (i.e., infection, inadvertent lesion to a branch of the median nerve, CRPS, which is a syndrome of chronic severe pain in the whole hand). To reduce the rate of unsatisfactory results and allow a quicker return to work, surgeons have developed methods to limit the size of the surgical skin incision (“minimally invasive techniques”), providing the same opening of the tunnel, either by a smaller incision (“mini-open” technique), by using an endoscope (one or two small skin incisions are needed to introduce the instruments), or by percutaneous technique (without any skin incision), under sonography. Spirecut develops the ideal surgical tool, which we call the Sono-Instrument®, to achieve the latter method for the great benefit of the patients. Note that the rate of pillar pain is approximately the same, whatever open or minimally invasive technique is used. Still, endoscopic and particularly percutaneous procedures allow quicker return to work and better preserve the patient’s grip strength. With the percutaneous technique, the patient may use and wash his/her hand the day after the operation.

What is the trigger finger?

The adult trigger finger (called, for the thumb, trigger thumb) is a disease characterized by a painful catching and then blockade of the finger in flexion. Frequently the patient cannot straighten the finger without the help of the other hand. In milder forms, the patient presents pain in the palm, at the base of the finger, or dorsally at the proximal interphalangeal joint. In the severe stage, the patient cannot fully straighten his or her finger, even passively, even with the help of the other hand. All fingers may be involved, but the disease most frequently concerns the ring finger and thumb. Sometimes several fingers are affected simultaneously – or at different moments of the patient’s life. People with diabetes are particularly affected. The association in the same patient with trigger finger – carpal tunnel syndrome is relatively frequent.

In most cases, the trigger finger is related to the flexor tendon sheath’s thickening, particularly its proximal annular reinforcement called the A1 pulley (several other pulleys). The role of the reinforced sheath is to maintain the flexor tendon(s) (that bend the finger) close to the finger bones. The gliding of the flexor tendon(s) is impaired, and over time erosions may be seen on their surface. The clinical diagnosis is relatively obvious, though experienced hand surgeons know other conditions also causing triggering phenomena. If needed, high-frequency sonography (echography) is used to confirm the diagnosis, usually demonstrating a thickened A1 annular pulley and impaired tendon gliding (dynamic evaluation).

A corticosteroid injection improves many patients, but the affection tends to recur some time after the infiltration. Surgical treatment is then offered, usually consisting of the thickened pulley section, suppressing the tendon’s impingement(s) in the flexor tendon sheath. A small incision does this in the palm. Though successful in most patients, there are complications: the surgical scar can be painful, or the finger may remain swollen for a long time after the operation; some patients present despite the operation with a persistent limitation of finger extension; serious complications are occasionally seen (infection, lesion of a digital nerve). After the operation, most patients cannot return to their daily and operational activities for two or more weeks. Spirecut has developed an original technique and a new surgical instrument (Sono-Instrument) to section the A1 annular pulley without a skin incision under sonography. The patient can return to all his/her activities the next day, including washing the operated hand.

Trigger fingers are also seen in young children, but the condition is quite different – though the surgical treatment is similar. However, the Spirecut trigger finger Sono-Instrument is not designed to be used in a young child.

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Carpal Tunnel / Sono-Instruments® (CT)

The Carpal Tunnel Sono-Instrument® is a simple and efficient solution to treat carpal tunnel syndrome.

Trigger Finger / Sono-Instruments® (TF)

The Sono-Instrument® is a simple and efficient solution to treat trigger finger.

Carpal Tunnel / Sono-Instruments® (CT)

The Carpal Tunnel Sono-Instrument® is a simple and efficient solution to treat carpal tunnel syndrome.

Trigger Finger / Sono-Instruments® (TF)

The Sono-Instrument® is a simple and efficient solution to treat one or several trigger fingers.