Dr. Joao Panattoni, a board-certified, fellowship-trained hand surgeon at Vero Orthopaedics, is excited about the advancements at the practice’s new offices and operating rooms on Indian River Boulevard that make it possible to expedite a diagnosis of carpal tunnel syndrome and simplify surgery if it is needed.
“Carpal tunnel release procedures can now be done endoscopically right in our new procedure room, under local anesthesia, with cutting-edge instruments, eliminating the need to go to the hospital operating room,” Dr. Panattoni said. “The recovery is immediate and there aren’t even any stitches. We simply dress the small half-inch opening and send the patient home to go on with their lives. They don’t need therapy. There are no restrictions.
And while we suggest being gentle with the hand for the first few days, the patient can’t alter the results of the surgery even if they start using it immediately.”
Carpal tunnel is caused by pressure on the median nerve which is the nerve that gives you feeling in your thumb and all the fingers except the pinky. When it goes through the wrist it passes through the carpal tunnel – a path that’s made of bone and ligament.
If the ligament in your wrist gets too stiff with swelling, the tunnel gets squeezed and pinches your median nerve.
Symptoms start out slowly with a burning, numbness, tingling or pain that is felt in your thumb and fingers, but not your pinky. The sensation may also travel up your arm. It often starts at night because most people tend to sleep with their wrists bent, which increases pressure on each side of the carpal tunnel. Shaking your hand may alleviate some of the pain temporarily. Eventually you’ll feel the symptoms during the day when you are doing something where your wrist is bent like driving a car or reading a book. Over time the symptoms intensify, and your fingers will feel swollen, and you’ll experience shocks that come and go in your thumb and fingers.
“Early detection is the key to the cure,” Dr. Panattoni explained. “Early diagnosis and treatment prevents the condition from getting worse. If you experience any of the symptoms, come in a get it evaluated. Just because you come in doesn’t mean we’ll suggest surgery, as we always try to treat it conservatively first with a splint or injection, but if you need surgery, the sooner the better. Once the muscle is compromised and you start to lose muscle mass it’s too late for a comprehensive cure. We can still perform a release surgery and the hand will ache less, but the numbness may last forever.”
That is why early ultrasound evaluation is critical according to Dr. Panattoni. “Our advanced ultrasound machine allows for early diagnosis by letting us see inside the nerve to check the size of the nerves. A diagnosis is much like putting together the pieces of a puzzle. We piece together the information we gather from the physical exam, the patient history and the ultrasound, and we’ll know right away if the patient has carpal tunnel or not.
“In most cases we don’t even have to do a nerve test because the ultrasound machine lets us see inside the nerve. We’re able to have an immediate diagnosis so there is no need to delay treatment.”
The ultrasound machine also helps with planning which procedure is best for the patient. By looking at the nerve from the inside, Dr. Panattoni can tell if there is something unusual or an anomaly that would cause the patient to be better suited for an open procedure vs. the more common endoscopic procedure. If the ultrasound doesn’t offer everything he needs to make the diagnosis, then a nerve test will be implemented. It’s all about putting the right pieces together to get the correct diagnosis.
There are two main types of carpal tunnel release surgery – open and endoscopic. In both cases the doctor cuts the ligament around the carpal tunnel to take the pressure off the median nerve and relieve your symptoms. After the surgery, the ligament comes back together but with more room for the median nerve to pass through.
Endoscopic release surgery is safer for the patient as it’s done with local anesthesia with ultrasound guidance in the procedure room instead of under anesthesia in a hospital operating room. The surgeon makes a small half-inch opening in the wrist and places a tiny camera in the opening to guide them as they cut the ligament.
“It’s really a simple, in-and-out procedure,” Dr. Panattoni assured. “There is no need to complicate matters by going to the hospital and seeing three or four medical professionals.
The process is simplified, and the sterility is proven to be more efficient and safer in the lab especially during the age of COVID. There is very little pain, no pre-op clearance, no fasting, and the patient doesn’t even have to undress and don a hospital gown.
“The best part is that there is no problem waking from sedation with that nauseous, uncomfortable feeling because the patient remains fully awake during the procedure. If the patient wants to talk to me, I can explain what I’m doing, or if he wants to put on headphones and jam to his favorite music while looking out the picture window, that works too.”
In some cases, open surgery is necessary, and it involves a larger cut – up to 2 inches from your wrist to your palm – and is done in an operating room.
“When you do open surgery, you have to open a lot of structures like the skin on the palm and the muscles and minor ligaments on top of the carpal tunnel ligament that aren’t really a factor for the nerve damage. This can lead to more complications and sometimes the patient ends up with pain that can last for several months after surgery and a long recovery,” Dr. Panattoni said.
“I much prefer the advanced capabilities of ultrasound-guided surgery because when I feel the ligament release, I can double-check it on the camera and actually see the separation of the ligament.”
Dr. Joao Panattoni earned his medical degree and completed his internship training from Faculty of Medicine of Marilia in Brazil and spent several years of specialized fellowship training in hand surgery and microsurgery at the Christine M. Kleinert Institute for Hand and Microsurgery in Louisville, Kentucky. He is certified by the American Board of Orthopaedic Surgery and is a member of the American Society of Surgery of the Hand. Prior to joining Vero Orthopaedics in 2018, Dr. Panattoni trained residents at Saint Louis University School of Medicine for nearly a decade in their orthopaedic residency program.
He can be reached at Vero Orthopaedics, 3955 Indian River Blvd., 772-569-2330 or you can schedule an appointment at veroortho.com.
Dr. Panattoni will be giving a free community presentation Jan. 26 at 6 p.m. in the new Vero Orthopeadics offices where he’ll demonstrate ultrasound evaluation with audience participation. Call 772-569-2330 for reservations.
