490 E. North Avenue
Suite 500
Pittsburgh, PA 15212
(412) 359-3895
Division of Upper Extremity
Mark E. Baratz, MD
Chris C. Schmidt, MD
Orthopaedic Spine Program
Mark A. Fye, MD
Division of Adult Reconstruction
James H. McMaster, MD
Richard L. Ray, MD
Nicholas G. Sotereanos, MD
Gerald W. Pifer, MD
Pediatric Orthopaedics Program
Mark J. Sangimino, MD
Stephani L. Schneck-Jacob, MD
Division of Sports Medicine
Patrick J. DeMeo, MD
Robert E. Schilken, MD
Edward S. Snell, MD (Primary Care Sports Medicine Specialist)
Foot and Ankle Program
Anthony D. Watson, MD
Division of Orthopaedic Truama
Jeffrey Sewecke, DO
by Kim Avolio and Mark E. Baratz, MD
You are in your third trimester and you wake up in the middle of the night with your fingers asleep. You shake it off and fall back to sleep. In the morning, you wake up and your hands are still feeling stiff and cramped. You may be suffering from carpal tunnel syndrome (CTS); a common ailment that affects about 1 in 4 pregnant women.
Carpal tunnel syndrome is common among diabetics, people with hypothyroidism and those individuals who suffer from rheumatoid arthritis. However, pregnant women face an increased risk of CTS due to hormonal effects, swelling, and weight gain. Physicians believe that these factors combined to reduce the space available within the carpal tunnel, a passage way in the palm containing the median nerve and the tendons that bend the fingers.
The symptoms that pregnant women should be aware of are burning, tingling or numbness in the thumb, index, middle or ring fingers. The symptoms may affect both hands and include wrist pain, weakness and a feeling that you have lost control of your fingers.
Your doctor will make the diagnosis of CTS by listening to your symptoms and by performing a physical examination. A test called a nerve conduction study may be ordered by your doctor to confirm the diagnosis and get a sense for the severity of the nerve damage.
CTS can be treated in a variety of ways. Initially, the wrist is splinted to keep the wrist and forearm in a straight line. Vitamin B6 taken in a dose of 100 mg once a day is felt to act as a mild diuretic (water pill) and may help reduce the symptoms of CTS. An injection of cortisone provides short-term relief of the pain and numbness associated with CTS in 80% of patients. If the symptoms persist surgery may be necessary.
Carpal tunnel release is a procedure where the transverse carpal ligament that forms the roof of the carpal tunnel is cut to relieve the pressure on the median nerve. It is important to recognize that carpal tunnel surgery is not a trivial operation. Whether it is done by an open, limited-open or endoscopic technique there is the risk that tendons, nerves or vessels will be injured. Dr. Baratz has been using the "Safeguard" system for carpal tunnel release (KMI Inc., San Diego) in selected patients. The KMI Safeguard system is designed to help perform limited-open carpal tunnel release. The "Safeguard" system is a device consisting of a knife and a guide. A guide is placed between the transverse carpal ligament and the median nerve. The knife is passed along a groove in the guide as it safely cuts the ligament. This system allows the doctor to be precise and to avoid injury to nerves, vessels, or tendons. This procedure is performed as an outpatient surgery. Recovery time varies according to how much you have to do with your hands, however light use is encouraged immediately after surgery.
Some helpful tips for preventing CTS include reducing your salt intake, and changing wrist positions frequently. The effects of carpal tunnel syndrome can be disturbing, but they almost always disappear after delivery of the baby.
More about Mark Baratz, MD.....
Orthopaedic Surgery Residency Program
Hand Surgery Fellowship at AGH
Allegheny General Hospital
American Academy of Orthopaedic Surgeons
KMI, Inc, The Small Bone Specialist
Pittsburgh Tribune-Review article with
Dr. Baratz
OBGYN Info website
The Health Pages-
Doctor and Patient Info
Dr. Baratz's Promotion to Director
Limited-open Carpal Tunnel Release;
Defining the "Safe-zone"
by Teddy Atik, MD, Brett Smith, MD, and Mark E. Baratz, MD
Placement of devices for endoscopic or limited-open carpal tunnel release (CTR) need to be precise to avoid injury to nerves, vessels or tendons. We examined the risk of injury using a novel device for CTR that consisted of a metal guide and knife.
An experienced hand surgeon, hand surgery fellow, and second-year orthopedic resident reviewed the technique for CTR using the "Safeguard" system (KMI, San Diego). Using 10 cadaver forearms, limited-open CTRs were performed by all three surgeons through a 1.5 to 2 cm incision just superficial to the superficial palmar arch. The "Safeguard" guide was intentionally placed off of the III/IV finger axis, either in 15 degrees of radial deviation or 15 degrees of ulnar deviation.
In nine specimens, limited-open CTR was safely performed by three surgeons of varying experience despite intentional, errant placement of the"Safeguard" guide and knife. In the final specimen, it was impossible to find an unsafe position for the guide unless the device was inserted within the bursal sac of the carpal canal. Proximity of neurovascular structures to the III/IV axis was measured to define a safe-zone applicable to any form of carpal tunnel release.
The "Safeguard" system for CTR appears to be a safe technique that permits a generous margin for error and short learning curves for surgeons of varying experience. The safe-zone is a graphic representation of structures at risk about the carpal tunnel. It is designed to enhance the surgeon's ability to perform CTR regardless of the technique chosen.
2. 1.5 cm; axis to motor branch of the median nerve (MBMN)
3. "Ground Zero"; axis to IIIrd common digital nerve
4. "Ground Zero"; axis to superficial arch
5. 1.0 cm; axis to ulnar nerve (UM) in Guyon's canal
6. 1.2 cm; axis to palmar cutaneous branch of the median nerve (PCMN)
B. Safe-zone when CTR is performed distal to proximal with Safeguard guide.
C. CTR performed proximal to distal through a progressively narrowing safe-zone.
Send it to mbaratz@wpahs.org