Ask the Doctor

What do you do when standard operations for carpal tunnel
and cubital tunnel syndrome simply do not work?

By Dr. John Taras
Reprinted here from the Summer 1999 "First Hand News"

Carpal tunnel and cubital tunnel syndromes are two of the most common upper extremity ailments. In these conditions, compression or entrapment of the median or ulnar nerve cause the hallmark symptoms of pain and numbness in the arm, hand, and digits. These syndromes usually respond well to treatment, but some patients continue to experience symptoms after surgery. In difficult cases, patients may undergo revision surgery that duplicates the first operation. Unfortunately, re-operation of this kind often fails to improve on the initial surgery, and patients remain symptomatic. Patients with persistent symptoms after surgery may also undergo endless physical therapy sessions without any real benefit. When repeat surgery and therapy fails, patients may hear the harsh words that the surgeon has nothing more to offer, and they must live with their discomfort.

To deal with this difficult and often relentless problem, a new surgical approach has been developed. This new procedure involves re-exploration of the failed surgical site and correction of any nerve compression. A section of vein is then wrapped around the damaged nerve. The added padding from the vein wrap protects and insulates the nerve from compression and other external forces that could cause scarring of the nerve. The type of therapy and duration of recovery from the saphenous vein wrap procedure is similar to that of simple nerve compression. The results of patients undergoing this new procedure are very promising. I am personally able to report a success rate of 80% in a preliminary series of patients having undergone repeat operations with the vein wrap procedure.

After this new procedure, patients consistently report fewer symptoms and better function compared to their preoperative states. Many patients report the ability to return to normal activity for the first time since the beginning of their original nerve compression symptoms. We are encouraged by these early results and will continue to study the effectiveness of saphenous vein wrapping. It is our hope that this procedure will provide relief to patients who historically have had little hope of recovery. For more information about this procedure, please feel free to contact the Philadelphia Hand Center, P.C.