MCH doctor uses uses minimally invasive method to treat carpal tunnel

An orthopedic surgeon at Monadnock Community Hospital is one of only two surgeons in New England performing a carpal tunnel procedure that only requires local anesthesia and a tiny incision.  

According to the Mayo Clinic, the carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand, and carpal tunnel syndrome is caused by pressure on the median nerve. When the nerve is compressed, it can cause numbness, tingling and weakness in the hand and arm. The anatomy of the wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.

The ultrasound-guided intervention for carpal tunnel release is a minimally invasive treatment, which uses a special device called the UltraGuideCTR to transect the transverse carpal ligament. 

Dr. Bradley White, co-chair of surgical services at Monadnock Community Hospital, said he has been doing mini-open carpal tunnel releases throughout his over-30-year career, and that this new technique cuts the recovery time significantly for patients.

“The ultrasound becomes my eyes with this technique. With traditional open carpal tunnel releases, it can be a month or two before patients can do physical activity such as pushing on a wrench or squeezing a chainsaw trigger,” White said.

White said the ultrasound allows him to know exactly where the nerve, artery and tendons are without cutting the skin. The only incision required, he said, is a small one on the underside of the patient’s wrist.

“After inserting the device, I can see into it and it has balloons that inflate,” he said. “You don't have to cut fat. You don't have to cut the superficial fascia, which is another kind of gristle layer in the palm. So you can get right to work on the ligament, which is called the transverse carpal ligament, TCL.”

One of White’s patients that he recalled having a traditional carpal tunnel surgery was a man with very large hands -- what he referred to as “meat hooks.” 

“He was a big guy, a laborer with calloused hands and I did the old-fashioned technique over a year ago,” he said. “It was a month or more before he could grip and push without significant discomfort.”

A second patient who had the ultrasound technique reported at six days he was at 95 percent, White said, adding that for the majority of these surgeries there also no opioids necessary. 

Carpal tunnel syndrome is common, and an estimated 71 percent of patients receive surgical intervention as their primary treatment. The estimated cost of medical care for carpal tunnel syndrome in the United States is $2 billion a year, with median lost work times of just under 30 days, according to the Mayo Clinic. 

Sonex Health developed the device White uses. TJ McCaslin, the company’s practice development consultant, said it was first used with patients in 2017 but was not opened for the public until late 2019.

“This isn’t a new procedure. It’s a different surgical technique made possible with this technology,” McCaslin said, adding that after speaking with various thought leaders in the industry, he has been told the procedure could become the gold standard in five to 10 years. “It’s still very new.”

The device – the UltraGuideCTR -- is currently being used at Alice Peck Day Memorial Hospital in Lebanon, which is affiliated with Dartmouth Hitchcock Medical Center in Hanover and two non-surgeon physicians in Boston, McCaslin said.

For now, White, who said he is not always someone to jump on board with new technology, is embracing the technique. He said he has performed it on patients ranging in age from their late 30s to 97.

“[The 97-year-old] would not have done the open surgery,” he said. “They’re already talking about coming in and getting the other one done.”