The Perc-Carpal Tunnel Scar Release (Perc-CT SR)
Your Trusted Alternative to Carpal Tunnel Surgery
Meet the Perc-Carpal Tunnel Orthobiologic Scar Release (Perc-CT SR Procedure)
Called the Perc-Carpal Tunnel Scar Release (Perc-CT SR Procedure), we have been using this orthobiologic ultrasound-guided hydrodissection for many years with excellent results. It’s similar to the standard ultrasound-guided carpal tunnel hydrodissection, but instead of using the high-dose steroid, which can hurt nerves and tendons (1, 2), we use the patient’s own platelet-derived growth factors that can help nerves repair through cytokines like NGF, PDGF, and IG-1 (3, 4) found in platelet lysate, or platelet rich plasma (PRP).
The platelet lysate contains growth factors concentrated from the patient’s own platelets, and it’s precisely injected around the nerve. In our experience, this frees up the compressed nerve, reduces the inflammation, and improves blood flow to the area—all without harming the delicate biomechanics of the wrist, which is inevitable with carpal tunnel release surgery. The Perc-CT SOR is the trusted alternative to carpal tunnel surgery.
Your Trusted Alternative to Carpal Tunnel Surgery
What are the Complications of Carpal Tunnel Surgery?
If and when both conservative care and steroid injections fail, many patients are referred for surgical consultation. Carpal tunnel surgery involves cutting the roof of the carpal tunnel which is made up of the transverse carpal ligament. In doing so the compressed/irritated median nerve is relieved. There are many different ways this can be accomplished including using open surgery, endoscopically, or using ultrasound and a cutting device. A newer solution, nerve hydrodissection not does involve cutting the transverse ligaments but frees us the scar tissue around the nerve. Surgical complications can and do exist (8). They include:
- Nerve damage
- Instability in the wrist bones due to the cutting of a critical ligament
- Failure of the procedure to relieve symptoms
- Pain at the surgical site
- Complex regional pain syndrome (CRPS)
Not Sure If You Have Wrist Tendonitis or Carpal Tunnel?
If you have not received a diagnosis, and you are not sure what you have – carpal tunnel, tendonitis, or something else – we recommend having a telehealth consultation with our doctors, if you’re not in the state of Colorado. And if you are in Colorado, we recommend you come in to have us take a look through ultrasound.
Dr. John Schultz, Co-Founder of Centeno-Schultz Clinic, describes how you can tell the difference for yourself between tendonitis of the wrist and carpal tunnel syndrome. The good news is that we treat both!
Watch a Median Nerve Hydrodissection
In your wrist, there is an area where your wrist meets your hand, called the “carpal tunnel.” Tendons and your median nerve go through this area, and the tightest against the transverse carpal ligament, which serves as the “roof” of the tunnel. When the nerve gets compressed (or squished) and irritated, this causes carpal tunnel syndrome, and about 4% of adults will have this problem at some point (9).
Regrettably, often carpal tunnel syndrome surgery involves cutting the transverse carpal ligament, the “roof” of the carpal tunnel. Using open surgery, endoscopically, or using ultrasound guidance with a cutting or snipping tool, the “roof” is cut to ‘release’ compression on the median nerve. However, the transverse carpal ligament has a structural role to play for the hand and wrist as a whole, which can lead to complications. The type of surgery – again, via open surgery, endoscopically, or through image guidance – dictates how long the recovery ends up being.
If you have enough atrophy at the base of the thumb due to the compression of your median nerve and the carpal tunnel, then it is very likely you need surgery. This means that the abductor pollicis brevis (APB) has gotten smaller on one side and not the other.
If it’s just numbness in the thumb and index finger so far, with or without cramping, then you probably do not need carpal tunnel syndrome surgery and could opt for physical therapy as your first line operation in your treatment. However, if that does not work, don’t simply think that surgery is your next step. The next step is called nerve hydrodissection, which the Perc-CT SOR procedure is a superior example of.
- Open surgery – In this surgery, the transverse carpal ligament is cut and the incision is closed. This procedure is the most invasive of all carpal tunnel treatments.
- Endoscopic surgery – The surgeon uses an endoscope to look at the nerve, tendons, and ligament, and the transverse ligament is cut, thereby creating the same problems as open surgery but without the collateral damage of open surgery.
- Ultrasound-guided Release – This procedure uses ultrasound to see and cut the transverse carpal ligament.
Open surgery – a trial showed 45% of patients had relief by 3 days and 55% of patients with open surgery were better in one month.
Endoscopic Surgery – 57% of patients had early relief while 63% had complete relief of symptoms after one month (3).
66% of patients who had open surgery and 77% of patients with endoscopic release showed complete relief by 6-months.
(1) Halpern AA, Horowitz BG, Nagel DA. Tendon ruptures associated with corticosteroid therapy. West J Med. 1977;127(5):378–382. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1237870/ [Google Scholar]
(2) Mackinnon SE, Hudson AR, Gentili F, Kline DG, Hunter D. Peripheral nerve injection injury with steroid agents. Plast Reconstr Surg. 1982 Mar;69(3):482-90. https://www.ncbi.nlm.nih.gov/pubmed/7063571
(3) Sowa Y, Kishida T, Tomita K, Adachi T, Numajiri T, Mazda O. Involvement of PDGF-BB and IGF-1 in activation of human Schwann cells by platelet-rich plasma. Plast Reconstr Surg. 2019 Aug 27. doi: 10.1097/PRS.0000000000006266.
(4) Sánchez M, Anitua E2, Delgado D, Sanchez P, Prado R, Orive G, Padilla S. Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expert Opin Biol Ther. 2017 Feb;17(2):197-212. doi: 10.1080/14712598.2017.1259409.
(5) Senna MK, Shaat RM, Ali AAA. Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome. Clin Rheumatol. 2019 Aug 16. doi: 10.1007/s10067-019-04719-7.
(6) Uzun H, Bitik O, Uzun Ö, Ersoy US, Aktaş E. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome. J Plast Surg Hand Surg. 2017 Oct;51(5):301-305. doi: 10.1080/2000656X.2016.1260025.
(7) Güven SC, Özçakar L, Kaymak B, Kara M, Akıncı A. Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study. J Tissue Eng Regen Med. 2019 May;13(5):709-714. doi: 10.1002/term.2815.
(8) Karl JW, Gancarczyk SM, Strauch RJ. Complications of Carpal Tunnel Release. Orthop Clin North Am. 2016 Apr;47(2):425-33. doi: 10.1016/j.ocl.2015.09.015.
(9) Ibrahim I, Khan WS, Goddard N, Smitham P. Carpal tunnel syndrome: a review of the recent literature. Open Orthop J. 2012;6:69–76. doi: 10.2174/1874325001206010069.