Carpal Tunnel Syndrome (CTS) is a condition brought on by increased pressure or a pinched nerve at the wrist. Symptoms may include numbness, tingling and pain in the arm, hand and fingers. Dr. Kobza performs this surgery through a very tiny incision (endoscopically) in the wrist to relieve the pressure on the nerve. He is one of only a handful of surgeons formally trained to perform this surgery in this manner.

The cause of carpal tunnel syndrome (CTS) is usually unknown. Pressure of the nerve can occur from swelling of the lining of the flexor tendons, called tenosynovitis, joint dislocations, fractures and arthritis can narrow the tunnel.

The symptoms are usually pain, numbness, tingling, or a combination of the three. Most often, the numbness or tingling takes place in the thumb, index and middle fingers.

A detailed history including medical conditions, how the hands are used, and whether there were any prior injuries is important. A nerve conduction test, called an EMG/NCV is usually done to check for other sites of nerve problems as well as to evaluate the carpal tunnel.

Dr. Kobza's endoscopic approach for carpal tunnel release allows for recovery to take place in a splint for 10 days. Afterwards, a few sessions of therapy may be needed and patients are back to their activities pain free.

Dr. Kobza treats all forms of wrist pain from simple pains that plague many people to more complex injuries. He routinely sees injuries from sports trauma resulting in fractures and shoulder / rotator cuff injuries to problems occurring from work related conditions.

Wrist Treatment

"Often times my patients only require pain medication and formal therapy to relieve many common symptoms related to their condition. Joint injections also are very helpful in relieving symptoms. The injection only takes a few moments to perform with minimal discomfort and can provide long lasting relief," says Dr. Kobza

Complex injuries may require surgery. "I prefer to use an arthroscopic approach (scope) to visualize the joint structures. I find that an arthroscopy is often the best way of assessing the integrity of the ligaments, cartilage and bone." I also use the arthroscope to repair the TFCC (triangular fibrocartilage complex) which is a common location of pain and injury.

After wrist arthroscopy you will most likely be placed into a wrist splint that allows full mobility of your fingers.

"Arthritis occurs when the lining of a joint (cartilage) wears out, resulting in direct contact between the bones," Dr Kobza relates. The thumb is a common location to develop arthritis.

The thumb joint, also known as the CMC joint, is a specialized saddle – shaped joint that is formed by a small wrist bone (Trapezium) and the bones in the thumb. The specialized shape of this joint allows the thumb its wide range of motion, up and down, across the palm and the ability to pinch with the finger.

Diagnosis

The appearance of the thumb and location of the pain are usually very helpful in identifying this condition. X-rays are also used to delineate this condition.

Treatment Options

Often, patients respond to non-surgical care. Pain medication, splinting, and limited use of corticosteroid injections may help alleviate pain.

A variety of surgical techniques are available that can successfully reduce or eliminate pain and improve thumb position and function. "Joint replacement has been very helpful for my patients" states Dr. Kobza.

• Fractures and Dislocations
• Sports Medicine
• Occupational Injuries
• Tennis Elbow
• Fracture surgery for fingers, hand, wrist, forearm, elbow, shoulder
• Ligament repair and reconstruction
• Tendon repairs
• Joint Replacement
• Wrist, elbow and shoulder arthroscopy (MIST)
• Finger Surgery
• Neurovascular repair
• Soft tissue repair
• Reconstruction of Tendons and Ligaments