• New Ways to Treat Carpal Tunnel Syndrome

      Sir James Paget

      Sir James Paget | Pathologist
      Image: MaterialScientist

      Sir James Paget and James Putnam

      Although we may think that carpal tunnel syndrome is a relatively new disorder, which came about during the computer age, it was actually originally described by Sir James Paget in 1854. James Putnam, a Boston neurologist, published the first clinical study of 37 patients with carpal tunnel syndrome in 1880 and Learmonth performed the first carpal tunnel release surgery at Mayo in 1933.

      Open Carpal Tunnel Release Surgery Or Open Release

      However, up until the 1960s, when carpal tunnel syndrome and its treatment options became fairly well defined, there was still no clear consensus on how to treat the condition. In fact, up until the late 1940s, resection of the first rib was a common treatment for this diagnosis! Once medical opinion coalesced about the cause of the disorder, a standard surgical treatment quickly developed, known as “open carpal tunnel release surgery,” or “open release.”

      Open Release Surgery

      During open release surgery, the transverse carpal ligament is cut, which releases pressure on the median nerve and subsequently relieves the symptoms of carpal tunnel syndrome. A 1 – 1 ½ inch incision is made at the base of the palm of the hand, allowing the surgeon to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The ligament is left open, and this decreases the pressure on the median nerve in the carpal tunnel. This sectioning of the ligament does not result in any loss of function.

      With the traditional open release surgery, the hand can remain swollen and tender for a couple of months. Full use of the hand, especially during gripping and grasping activities, can sometimes take up to 6 to 8 weeks, or possibly longer.

      Endoscopic Release

      Endoscopic release is a relatively new technique, which uses a thin tube with a camera attached (endoscope). The endoscope is guided through a small incision in the wrist, allowing the surgeon to see the transverse carpal ligament without opening the entire area with a large incision. A miniature blade, inserted through the tube, is used to cut the transverse tunnel ligament.

      SmartRelease Full Assembly

      MicroAire® SmartRelease® Endoscopic Carpal Tunnel Release System Image: microaire.com

      Smart Release Procedure Illustration

      MicroAire® SmartRelease® Endoscopic Carpal Tunnel Release System Image: microaire.com

      Here is a quick video of the endoscopic release procedure.

      Relief Of Symptoms Of Endoscopic Release

      The relief of symptoms of endoscopic release are similar to the traditional open technique. However, you can expect a less post-operative pain and a shorter recovery period after endoscopic carpal tunnel release, because the procedure does not require cutting the palm open and disturbing a large area of the hand. As a result, you can return to work or practicing sports earlier, especially sports that require gripping, such as golf and tennis. Endoscopic release also produces a smaller scar with less swelling and scar-related pain.

      Call Us!

      If you suspect that you have carpal tunnel syndrome, please give us a call and let one of our physician’s determine the cause of your pain, and know that should you need surgery, we will offer you the most innovative and safe treatment available.

      Healing Faster With The Body’s Help: Platelet Rich Plasma Therapy (PRP)

      The body’s incredible capacity to heal itself merits a simple question: if we know the mechanisms and molecules involved, could we concentrate them at the sight of an injury and hasten recovery? Amazingly, the answer is yes, and it’s the basis for an innovative treatment known as Platelet Rich Plasma therapy (PRP).

      Let’s break that down. Blood plasma is the fluid in which our blood cells swim. Platelets are small cell fragments—also present in blood but at a low concentration—that play a key role in the clotting and healing of injuries.


      In PRP, the patient provides a sample of blood that is centrifuged down to separate the platelets from the plasma and red blood cells. The highly concentrated platelets are then prepared in a fluid injection, hence the name Platelet Rich Plasma therapy.

      But how does this work? Increasing the platelet’s concentration augments the entire assembly line of molecules and reparative cells involved in healing. That’s because normal blood consists of about 93% red blood cells whereas PRP consists of 95% platelets. By directly injecting such a high concentration of platelets at the site of the injury, we’re able to stimulate healing in the bone and soft tissue faster than the body’s own natural process.


      PRP used to be reserved for pro-athletes whose careers depended upon the short healing times it provided. But now the technique has gone mainstream, and has become one of the go-to options for injuries such as tennis elbow, Achilles tendinitis, and runner’s knee.

      In some cases, PRP therapy can eliminate the need for surgery or, if surgery is warranted, be applied as part of the procedure to accelerate rehabilitation. And while recovery times vary from patient to patient, studies have shown that PRP can accelerate healing by up to 40% for certain conditions.

      The only catch is that PRP is not a panacea for any and every injury, but that’s why we’re here to answer any questions you may have and find out if PRP might be the best option to get you back in form.


      A Shot of Relief: Knee Injections – What You Need to Know

      “Ouch, my knee!”

      These words are said all-too often by sufferers of early-onset arthritis, especially towards the end of August when all those outdoor runarounds really start to add up.

      When simple anti-inflammatory medicine, ice, and rest are not enough to calm these episodes of knee pain and inflammation, there is yet another option: knee injections.

      There are two types of knee injections:

      • Cortisone injections
      • Lubricant injections

      For acute pain that requires fast relief, we recommend cortisone shots. They deliver anti-inflammatory and pain relieving medication directly into the knee joint, a process that works both faster and longer than pills, which have to work their way through the body and must be taken daily.

      And though cortisone is a steroid, it has been found to be one of the safest forms of non-surgical treatment for individuals of all ages. Often all that is needed is one quick injection to experience relief for anywhere from 2 weeks to 3 months. The only downside is that it involves a needle!

      The second most common form of knee injections are lubricant injections. They are not meant to treat short-term knee pain, but rather, they work to reduce long-term symptoms through the use of hyaluronic acid. Hyaluronic acid is a lubricant that is naturally produced by the knee, so introducing a concentrated mixture into the joint helps add an additional buffer on the tendons, ligaments, and muscles in order to relieve knee pain over time.

      Lubrication injections require at least three injections over 3 weeks before you feel the effects and thus are not recommended for individuals looking for immediate pain relief.

      Even the most pre-cautious athletes cannot entirely fend off the natural wear and tear that occurs from a life of sports, and often nowhere do we feel it more acutely than in our knees. The most important course of action remains prevention, but knee injections can be an effective treatment for keeping you exercising and healthy!


      No Surgery Required: Arthritis Edition

      Not every joint problem needs surgery. Some of the best work we do at Manhattan Orthopedic & Sports Medicine Group falls into the wider category of non-invasive treatment options, a salient point particularly for arthritis sufferers.

      A little background: Arthritis refers to the wearing out or malfunctioning of a normal joint and is classified as being either localized or systemic. Orthopedists specialize in the former, which refers to arthritis resulting from injuries or degenerative diseases that affect a single joint. Non-surgical treatments for localized arthritis involve a highly focused array of solutions on a case-by-base basis, including:

      • physical therapy
      • anti-inflammatory medication
      • steroid and lubrication injections
      • platelet rich plasma injections.

      Conversely, systemic arthritis is a systemic condition that affects multiple joints at the same time and is thus treated by rheumatologists. Systemic conditions are usually the result of autoimmune disorders, such as

      • rheumatoid arthritis
      • psoriatic arthritis
      • lupus arthritis
      • Lyme disease

      are primarily treated with medication rather than surgery.

      Identifying the most effective non-invasive treatment for arthritis requires a simple understanding of joints. Joints use ligaments for stabilization, synovium for lubrication, and articular cartilage to cover and protect the bones themselves.

      The joint’s interconnected architecture leads to some frustrating realities. As one element wears out, the rest of the tissues weaken as the surrounding muscles atrophy and degeneration progresses.

      There are, however, a number of treatments that can relieve the pain and possibly slow the process, a few of which were mentioned above. To start, physical therapy can be used to prevent stiffness and strengthen both the muscles and ligaments in the affected joint. Anti-inflammatory medications such as Ibuprofen (Advil) and Naproxen (Aleve) can help reduce joint swelling (synovitis). This lessens the amount of destructive enzymes in the joint.

      Similarly, steroid injections can temporarily decrease pain and swelling and allow you to retain everyday movement as you follow an ongoing regimen as prescribed by your physician. There are also certain injections for the knee, known as visco-supplementation that can provide better lubrication and increase range of motion.

      The use of platelet rich plasma in a joint remains unproven, but may be considered if surgery is too great a risk.

      Most arthritis treatments should begin far before discussions about surgery. However, individuals and injuries vary, so it’s important to understand how your age and condition may dictate different treatment options.

      To find out what non-surgical options are available for you, make an appointment with one of our experts here to tackle your arthritis for good!

      MAKOplasty®: Robotic Knee Surgery


      Manhattan Orthopedic & Sports Medicine is proud to announce ROBOTIC ASSISTED PARTIAL KNEE REPLACEMENT (MAKOplasty®). Through the use of a Robotic Arm our surgeons now perform more precise partial knee replacements using a MINIMALLY INVASIVE technique. This cutting edge technology helps restore a patient’s more natural knee motion. Read more…

      Get hip: The truth about hip implant safety.

      The media has recently identified the early failure of certain metal-on-metal hip implants as a modern peril in our rush to adopt new technologies. The problem with many of these reports, however, is that the few journalists have provided the proper context required for a reasonable assessment of hip implants over the past 40 years. Read more…

      Outlasting the Aging Process: Strategies for Long-Term Knee Health

      Advances in orthopedic medicine, sports sciences, and physical therapy have allowed for sustained, active lifestyles that only keep us healthier and heartier as we swim, bike, volley and swing our way into retirement. In particular, there has never been a better time for knees.

      Keeping your knees healthy begins with maintaining motion and strength through regular exercise. The catch-22, however, is that the more we exercise, the more wear and tear builds up, leading to arthritis. Read more…

      Extreme Lateral Interbody Fusion (XLIF)

      Interbody fusion surgery has been performed by spine surgeons for several generations. Indications range from disc herniations, infections, tumors, scoliosis, instability, and back pain. Traditionally these operations have been performed through a large incision across the abdomen or chest, in order to access the spine. Historically, interbody fusion surgery is a very effective method of achieving spinal fusion. However, with advances in technology, this procedure can now be performed in certain patients utilizing a minimally invasive surgical approach. Read more…

      Boutonniere Deformity Chapter

      Dr. Richard Gilbert has recently had a book chapter on Boutonniere Deformity published in the textbook “Plastic Surgery: Clinical Problem Solving.”

      You may purchase the book here.

      Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF)

      Lumbar spinal stenosis is a common condition affecting millions of Americans each year.  Nerve compression can cause pain, numbness, and weakness and can interfere with even simple daily activities.  When non-operative care fails to control the symptoms, surgery may be indicated.  This typically consists of spinal decompression, and possibly spinal fusion. Read more…