Sunday February 25, 1996

Balloon catheter relieves pressure on median nerve in carpal tunnel

A new procedure to alleviate carpal tunnel syndrome uses a balloon catheter to stretch and expand the ligament and relieve pressure on the median nerve in the carpal tunnel of the wrist. This avoids cutting the ligament when conventional therapy is not effective.

According to a study of 120 patients treated with the new procedure during the past four years, 85 percent had marked clinical improvement in relief of wrist pain and numbness, and 95 percent reported overall satisfaction with the outcome.

"The 20-minute outpatient procedure relieved pain and numbness and enabled patients to retain grip strength," said J. Lee Berger, MD, a practicing orthopaedic surgeon in Fair Lawn, N.J. who developed the procedure.

Dr. Berger, assistant clinical professor of orthopaedic surgery, Seton Hall Graduate School of Medicine, West Orange, N.J., presented the findings in scientific exhibit S 18.

The study was performed at St. Joseph's Hospital and Medical Center, Paterson, N.J. Patients returned to work in an average of 10 days (range: 1-28). "With traditional treatment, the patient is off work for at least six to eight weeks, " said Dr. Berger.

In addition, patients treated with the new procedure could bathe, dress, cook, and perform other activities of daily living in an average of four days (range: 1-7).

The procedure is done under local anesthetic and utilizes a balloon catheter device similar to an angioplasty balloon. To relieve the pressure on the median nerve in the hand, a balloon is inserted within the carpal tunnel through a small incision in the wrist.

Saline inflates the balloon, stretching the fibers of the ligament, which is then pushed upward. This creates space around the carpal tunnel. "As a result, there is no pressure on the median nerve, and we did not have to cut the ligament, thus preserving its biomechanics," Dr. Berger said. "We were able to expand the ligament by one-third. When the balloon is removed, the ligament stays stretched."

The new procedure also reduces the potential of scar formation in the carpal tunnel and decreases the likelihood of perineural fibrosis of the median nerve.

A custom-designed nerve protector protects the median nerve and flexor tendons in the carpal tunnel during balloon inflation. Doctors also use a pressure gauge monitor and a specially-designed hand holder during the procedure.

Average patient follow-up was done at two years. Dr. Berger said the new procedure is an extension of conservative management.

"If the patient should have a recurrence of symptoms, the procedure can be repeated or the patient could have the traditional open surgical treatment," said Dr. Berger. "Unlike open or endoscopic procedures, the new technique does not burn any bridges."

Dr. Berger is currently awaiting approval from the U.S. Food and Drug Administration so that the devices can become available for other physicians to use.

Co-author of the study with Dr. Berger is orthopaedic hand specialist Paul D. Fragner, MD, who is affiliated with White Plains Hospital, Westchester, N.Y.

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Last modified 27/September/1996