Benefits of Spirecut Products
The SPIRECUT technique and range of sono instruments offers a range of benefits and advantages over traditional wrist surgery.
No Skin Incision
Immediate Return to Daily Activities
Specific Instrument for Each Problem
Musculo-skeletal sonography (or echography) has dramatically expanded among medical specialties for diagnostic and interventional purposes, due to its affordability, portability and availability. High-frequency sonography can now been 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 anesthesia, in day clinic or in 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 as “needling” procedures). Sono-Instruments provide an adapted design to facilitate the introduction and safe release of the thickened tissue, and allow easy peroperative 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 it?
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 damages, so early diagnosis and treatment are essential. The diagnosis is usually made by nerve conduction studies and electromyography, sometimes by sonography, or both.
In early cases, non-operative treatment is advised, in particular wearing a night splint, keeping the wrist in 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 a surgical decompression, to give more room to the nerve. The classical operation is open surgery with section of the transverse carpal ligament, enlarging the tunnel. The incision is 4-5cm long. After the operation, the night pain usually quickly disappears, but the healing of the surgical wound takes time, preventing early return to daily activities and work. Many patients also complain of a transient decrease of their grip strength and of pain at the base of the wrist, called “pilar pain”, lasting months or sometimes years. Other complications are sometimes seen, some quite serious (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).
In order to reduce the rate of unsatisfactory results and to allow quicker return to work, the 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. Note that the rate of pillar pain is approximately the same, whatever open or minimally invasive technique is used, but endoscopic and particularly percutaneous techniques 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.
Spirecut develops the ideal surgical instrument, that we call Sono-Instrument, to achieve the percutaneous carpal tunnel release for the great benefit of the patients. The patient can go back to his/her daily activities the next day, and wash his/her hand.
SPIRECUT offers the latest techniques and sono-instruments for the treatment of carpal tunnel syndrome and trigger finger.
The adult trigger finger (called, for the thumb, trigger thumb) is a disease characterized by a painful catching then blockade of the finger inflection. Frequently the patient cannot straighten the finger without the help of the other hand. In milder forms, the patient presents some pain in the palm, at the base of the finger, or dorsally at the proximal interphalangeal joint. In the severe stage, the patient is unable to fully straighten his or her finger, even passively, even with the help of the other hand. All fingers may be involved, but the ring finger and thumb are most frequently concerned by the disease. Sometimes several fingers are affected at the same time – or at different moments of the life of the patient. Diabetics are particularly affected. The association in the same patient trigger finger – carpal tunnel syndrome is relatively frequent.
In most cases, the trigger finger is related to the thickening of the flexor tendon sheath, and particularly of its proximal annular reinforcement, called the A1 pulley (there are 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 its/their surface. The clinical diagnosis is relatively obvious, though experienced hand surgeons know other conditions also causing triggering phenomenons. 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).
Many patients are improved by a corticosteroid injection, but the affection tends to recur some time after the infiltration. A surgical treatment is then offered, consisting usually in the section of the thickened pulley, suppressing the impingement of the tendon(s) in the flexor tendon sheath. This is done by a small incision 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 a persistent limitation of finger extension ; serious complications are occasionally seen (infection, lesion of a digital nerve). After the operation, most patients cannot go back to their daily and working 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 go back 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.