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April 18, 2024
FOND DU LAC – It’s all in the release – at least for one area plastic surgeon.
Richard Schaefer, a board-certified plastic surgeon with the SSM Health Fond du Lac Regional Clinic, recently completed his 1,000th patient treated for carpal tunnel release (CTR) using UltraGuideCTR and real-time ultrasound guidance.
Carpal tunnel syndrome (CTS) is a common condition that affects an estimated 13 million people in the United States.
The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand.
When the median nerve is compressed, symptoms can include numbness, tingling and weakness in the thumb and fingers.
Left untreated, Schaefer said it can cause long-term debilitation.
“I’ve been with SSM Health Fond du Lac Regional Clinic since 2005,” he said. “I’ve always done traditional CTR. The ‘new way’ of doing (the surgery) has only been around at the clinic for about two and a half years. Because the procedure only takes a few minutes to complete, sometimes I’ll do six CTRs using the UltraGuideCTR in one day.”
With ultrasound guidance, Schaefer said CTR relieves carpal tunnel syndrome symptoms while minimizing recovery time.
The procedure, he said, relieves pressure on the median nerve by transecting or dividing the transverse carpal ligament, which forms the roof of the carpal tunnel to create more space for the nerve and tendons.
“(The procedure) allows the most comfortable, nicest patient experience while also providing an effective treatment with people who have CTS,” he said. “It’s all done with the patient wide awake. That might sound intimidating to a lot of people, but the procedure itself is well tolerated by every age group. The thing I’m most pleased with is the patient satisfaction after the procedure and how quickly patients can get back to their normal activities.”
Schaefer said the procedure starts by putting a bit of numbing medication in the wrist.
Richard Schaefer stands with the UltraGuideCTR ultrasound device. Submitted Photo
“The wrist is not real sensitive, so it tolerates the needle well,” he said. “Under ultrasound, additional numbing medication is put into the carpal tunnel.”
By doing it that way, Schaefer said, surgeons can see exactly where the needle is.
“You have good hand anesthesia for hours after the procedure,” he said.
The procedure, Schaefer said, involves a small stab incision in the wrist that is maybe an eighth of an inch in length.
“We put the UltraGuideCTR device through that little cut into the carpal tunnel,” he said. “The ultrasound device ensures we’re in the right place. Then we can take the pressure off the nerve to relieve the pain.”
The procedure using the UltraGuideCTR device, Schaefer said, takes only a few minutes to complete.
“From the time I walk into the office, chat with the patient, set everything up and put a bandage on their hand after the procedure, it’s about 15 minutes total,” he said. “We try to set (the appointments) up early in the day so patients can get on with their day.”
Most patients who undergo CTR using ultrasound guidance, Schaefer said, can return to normal activities in three to six daysd.
Other patient benefits include:
Aspirin or ibuprofen is typically enough for pain managementPostoperative hand therapy is typically not requiredImmediate motion of the hand for rapid recovery
In his experience, Schaefer said the fast recovery associated with CTR using ultrasound guidance has been impactful.
“The vast majority of patients who come in for the procedure are here because they don’t want to be restricted, out of work or missing their normal activities for a prolonged period,” he said. “At the four-day post-op visit, the incision is typically healed. We then clear patients to resume activity without restrictions. The overwhelming majority of patients have managed their post-op pain with over-the-counter medication.”
Schaefer offers this procedure in Fond du Lac, Ripon and Waupun.
Relief in other ways
Before deciding on surgery, Schaefer said “there are some things you can do to help relieve carpal tunnel pain.”
“A person can do nerve-gliding and stretches to relieve some symptoms,” he said. “Those are fine for people who have acute carpal tunnel – your hand is fine, you don’t have problems, but then you decide you’re going to paint the kitchen or knit a blanket. Suddenly, you have CTS, but that’s probably because you’ve been overusing your wrist in a way you’re not used to doing so – it’s probably temporary pain and will cease once the activity is stopped.”
Schaefer said the difference is when people use their wrist/hand abundantly for their lifestyle.
“Whether that’s working at a factory or simply the aging process,” he said. “It’s not everybody, but as we age, the carpal tunnel itself is an arch of bone and joint spaces shrink over time, so some of those bones start to collapse into one another.”
How it used to be
Despite the UltraGuideCTR being a popular choice among patients today, Schaefer said 75% of CTRs being done today “are still done via the old-fashioned way.”
“That just means patients are still having a lot of time off from work, etc.,” he said. “The traditional operation, whether it involves sedation or not, involves about a one-inch incision on the palm. Then the procedure goes down deep in the palm taking that same pressure away from the nerve. The problem with (the old way) is the one-inch incision hurts for a longer time. The traditional way of doing things, in my humble opinion, doesn’t offer the easiest recovery that’s available.”
Richard Schaefer said currently, only about 25% of carpal tunnel release procedures are done using UltraGuideCTR. Submitted Photo
Schaefer said he thinks there is one main reason why more hospitals/clinics have not adopted the new method using UltraGuideCTR.
“Sometimes it’s hard to teach old dogs new tricks,” he said. “The trickier that trick is, the harder it is to teach. This new technique involves some new sophistication with the ultrasound machine. It’s just a matter of preference for hospitals/clinics.”
A patient experience
Steven Sobeck, an anesthesiologist, is one patient who said they benefited from using UltraGuideCTR.
Sobeck said he first encountered Schaefer for a traditional endoscopic carpal tunnel surgery on his right hand.
“It took me a good five to seven days before I could use my hand again,” he said. “Even then, I still had significant discomfort for at least two weeks. It took almost one month before I was back to normal.”
A few months later, Sobeck said he returned for the new ultrasound-guided carpal tunnel surgery on his left hand.
“I was able to use my hand the same day,” he said. “I skipped an entire week of recovery. I was essentially back to normal within two weeks. The ultrasound surgery was completely pain-free.”
Other procedures
Despite completing 1,000 UltraGuideCTR procedures in the last two and one-half years, as a plastic surgeon, Schaefer said he still has plenty of time to do other surgeries.
He is trained in the surgical and non-surgical rejuvenation of the face, eyes, nose, lips and forehead.
He also specializes in breast surgery, hand surgery, skin cancer removal and reconstruction, total body lift after massive weight loss and pediatric plastic surgery.
“Because the CTR operation doesn’t take that long, I still have plenty of hours in the day to do other procedures,” Schaefer said. “If I do a breast reduction surgery, one patient, one procedure, that’s a three-hour endeavor for me. The short procedure time for CTR has allowed me to reach that 1,000 milestone rather quickly.”
