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Frequently Asked Questions

Carpal Tunnel Syndrome (CTS) FAQs

MANOS™ FAQs

Medical Professional FAQs

Carpal Tunnel Syndrome FAQs

What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome is a condition caused by pressure on the median nerve within the carpal tunnel. The median nerve travels from the arm to the hand through the Carpal tunnel and supplies feeling and movement to parts of the hand such as the palm, thumb, index finger, middle finger, and thumb side of the ring finger.

What is the Carpal Tunnel?
The carpal tunnel is a narrow, tunnel like structure at the base of the hand. The bottom of the tunnel is made up of the wrist bones, and the top of the tunnel is covered by the transverse carpal ligament. The tunnel houses nine tendons and the median nerve as they run from the forearm to the hand.

What are the symptoms of Carpal Tunnel Syndrome?
Symptoms of carpal tunnel syndrome can include numbness or tingling in the thumb, palm, and fingers, pain in the hand or wrist, lack of coordination with fingers, and weakness in the hand.

What are the causes of Carpal Tunnel Syndrome?
The cause of carpal tunnel syndrome is pressure on the median nerve. That pressure is generally caused by swelling due to repetitive movements of the hand or wrist, but could also be due to another existing condition. Common conditions associated with carpal tunnel syndrome include rheumatoid arthritis, diabetes, obesity, and hypothyroidism.

Can I get Carpal Tunnel Syndrome during pregnancy?
It is not uncommon for women who are pregnant to develop carpal Tunnel Syndrome. This is caused when excess liquid due to edema or hydropsy puts pressure on the carpal tunnel. Symptoms most often occur at night, when a pregnant woman is laying down and excess liquid is redistributed throughout the body.

Who is at risk for developing Carpal Tunnel Syndrome?
Carpal tunnel syndrome can affect anyone. But people who regularly do repetitive motions of the hands and wrist, and people who are obese, or are affected by diabetes or rheumatoid arthritis have a higher risk of developing carpal tunnel syndrome.

How do I treat Carpal Tunnel Syndrome?
Wearing a wrist split, applying hot and cold compresses, taking anti-inflammatory medicines, certain exercises, and changing the way you do repetitive motions can all be useful for temporary relief of carpal tunnel syndrome symptoms. For most people, these conservative treatments are effective. But when conservative treatment is ineffective, Carpal Tunnel Release (CTR) surgery is normally recommended.

How can Carpal Tunnel Syndrome be prevented?
The risk of carpal tunnel syndrome can be reduced by limiting the number of repetitive wrist movements you perform whenever possible. Using tools and equipment that function to reduce the risk of wrist injury such as ergonomically designed split keyboards, keyboard trays, typing pads, and wrist braces can also help. Finally, take frequent breaks when typing and always stop if there is tingling or pain in your hands or wrists.

Can Carpal Tunnel Syndrome worsen if not treated?
Yes. If left untreated CTS can cause permanent nerve damage, weakness, numbness, tingling, and atrophy of hand muscles.

Can Carpal Tunnel Syndrome cause pain in other areas ?
CTS causes pain primarily in the fingers and hand. However, as the condition becomes more severe, pain can be felt in the affected arm, radiating as far up as the shoulder.

Can Carpal Tunnel Syndrome return after surgery?
Yes. Although reoccurrence is rare and generally due to incomplete release of the transverse carpal ligament (TCL).

Can Carpal Tunnel Syndrome be cured?
CTS can be successfully treated. But, because the dimensions of the carpal tunnel are fixed, individuals with smaller tunnels will always be susceptible to CTS. Carpal Tunnel Release (CTR) surgery changes the dimensions of the carpal tunnel by cutting (releasing) the ligament that covers the carpal tunnel. The additional space gained cures CTS in the vast majority of patients, as any continued expansion/swelling within the carpal tunnel will no longer result in compression of the median nerve.

Will Carpal Tunnel Syndrome go away without treatment?
It is unlikely that symptoms of carpal tunnel syndrome will dissipate if left untreated and no lifestyle changes are made.

Does Carpal Tunnel Syndrome cause swelling?
No. Carpal tunnel syndrome is, itself, caused by pressure due to swelling of the area surrounding the median nerve located in the carpal tunnel.

Does ice help Carpal Tunnel Syndrome?
Cold and/or hot compresses on the wrist can temporarily relieve mild swelling but are not considered to be viable long-term treatment options.

What kind of doctor treats Carpal Tunnel Syndrome?
In mild and moderate cases treated with conservative care, your primary care physician will likely determine most of the treatment, but may refer you to a physical therapist. In surgical cases, often patients are referred to a neurologist for testing to confirm the diagnosis before surgery. A wide array of surgeon specialties commonly performs the surgery, including hand surgeons, orthopedic surgeons, neurosurgeons, general surgeons, and plastic surgeons.

What is the best treatment for Carpal Tunnel Syndrome?
Conservative treatment should always be exhausted before any surgery, including before CTR surgery, is performed. When conservative treatment is ineffective, the best option is carpal tunnel release surgery.

MANOS™ FAQs

What is the difference between carpal tunnel release surgery performed with MANOS™ and other carpal tunnel release methods?
The MANOS™ Carpal Tunnel Release System affords a much less invasive technique than is used traditionally for CTR surgery. Whether CTR is performed using MANOS™, or performed traditionally, the goal of procedure is the same. The transverse carpal ligament is cut (released), relieving the pressure on the median nerve. With MANOS™ however, this can be done without a palmar incision. Instead surgical access is gained at the wrist and can measure as little as 2mm. This greatly reduces surgical trauma, post-operative care, post-operative pain, and patient recovery time.

Is CTR with MANOS™ considered major surgery?
No. CTR is one of the most common surgeries performed in the US, and is almost exclusively an outpatient procedure.

How long is the patient recovery time after CTR with MANOS™?
Patients recover quickly, with some returning to work the same week of surgery. Some patients have even gone back to work the very next day.

How does the MANOS™ Carpal Tunnel Release System work?
MANOS™ allows surgeons to do what they have always done in CTR surgery, which is cut the transverse carpal ligament. But with the MANOS™ system they are able to do so in the least invasive manner available today. This is because the device is just 2.1mm in diameter. After mapping the surgical site, gaining access to the carpal tunnel, and safely positioning the device inside the wrist, the surgeon exposes the device’s cutting surface. He then makes several short passes of the unidirectional blade to cut through the TCL.

Are there any risks to be aware of when considering CTR performed with MANOS™?
Any surgery, including CTR surgery comes with risk. The most common risk associated with CTR surgery is damage to non-target tissues like tendons, nerves, or vascular structures (arteries/veins). These same risks apply to CTR performed with MANOS™. The median nerve is very important, as it provides motor and sensory function to most of the hand. MANOS™ is designed with numerous features to help the surgeon to avoid the median nerve and other non-target tissue, including exacting land-marking steps, and compatibility with intra-operative nerve stimulation and ultrasound guidance.

Does CTR with MANOS™ require anesthesia?
Yes. But when using MANOS™ to perform CTR, general anesthesia can be avoided. Instead, a local anesthetic is used, which has several benefits. The use of local anesthetic eliminates the significant cost/staff requirements of general anesthesia, it allows the patient to stay awake during the procedure to provide feedback to the surgeon during the surgery, and eliminates the side effects of general anesthesia.

How was the MANOS™ system developed?
The MANOS™ system was developed by San Francisco-area neurosurgeon, Dr. Bruce McCormack. Dr. McCormack was convinced that eliminating the palmar incision traditionally used in CTR would drastically improve patient outcomes. Dr. McCormack founded Thayer™ with med-tech entrepreneur Jeff Smith, and formed a team to bring the technology to market. Several iterations of the device were tried until the current design was created. Thayer™ continues to use surgeon and patient feedback to make improvements to the MANOS™ system.

How long does the Carpal Tunnel Release procedure take when performed with MANOS™?
Carpal Tunnel Release with the MANOS™ is pretty fast. It’s normally done in about ten minutes.

Where can I find a certified MANOS™ surgeon in my area?
Use our surgeon locator to find one in your area.

Will my insurance cover CTR performed with MANOS™?
Reimbursement is straightforward. There are two reimbursement codes available for CTR. It is up to each surgeon and healthcare facility to decide which code is most appropriate.

Medical Professional FAQs

What is the difference between MANOS™ and other CTR systems?
Most other CTR systems involve an endoscope. While endoscopic CTR is widely viewed as safe, effective, and beneficial to patient recovery time, it has not been widely adopted. Endoscopic systems typically employ instrumentation measuring 5mm-10mm in diameter. MANOS™ measures just 2.1mm in diameter, keeping surgical access to a bare minimum. Endoscopic blades work like a scalpel, easily cutting through anything in its path and providing little or no tactile or audible surgeon feedback. The MANOS™ cutting surface is a unidirectional saw. It is only effective at cutting when the surgeon engages it by pressing down on the TCL with his fingers. While cutting, the surgeon is receiving continuous audible and tactile feedback, which he uses to determine when the TCL is completely released. Expensive optical equipment needed for use with endoscopic systems is not required with MANOS™. MANOS™ is compatible with intra-operative nerve stimulation and ultrasound guidance.

How does the MANOS™ system work?
MANOS™ allows surgeons to do what they have always done in CTR surgery, which is cut the transverse carpal ligament. But with the MANOS™ system they are able to do so in the least invasive manner available today. This is because the device is just 2.1mm in diameter. After mapping the surgical site, gaining access to the carpal tunnel, and safely positioning the device inside the wrist, the surgeon exposes the device’s cutting surface. He then makes several short passes of the unidirectional blade to cut through the TCL.

Does CTR performed with MANOS™ require anesthesia?
Yes. But when using MANOS™ to perform CTR, general anesthesia can be avoided. Instead, a local anesthetic is used, which has several benefits. The use of local anesthetic eliminates the significant cost/staff requirements of general anesthesia, it allows the patient to stay awake during the procedure to provide feedback to the surgeon during the surgery, and eliminates the side effects of general anesthesia.

What research has been done on the MANOS™ system?
Click here to go to our clinical data page

How was the MANOS™ Carpal Tunnel release system developed?
The MANOS™ system was developed by San Francisco-area neurosurgeon, Dr. Bruce McCormack. Dr. McCormack was convinced that eliminating the palmar incision traditionally used in CTR would drastically improve patient outcomes. Dr. McCormack founded Thayer™ with med-tech entrepreneur Jeff Smith, and formed a team to bring the technology to market. Several iterations of the device were tried until the current design was created. Thayer™ continues to use surgeon and patient feedback to make improvements to the MANOS™ system.

What about variations of the motor branch?
There are three. Extraligamentous is the most common, where the path of the motor branch separates from the median nerve distal to the TCL, and travels in a retrograde fashion radially to the thenar muscles. A subligamentous pathway occurs less frequently, when the motor branch separates from the median nerve within the carpal tunnel, and makes its way radially to the thenar muscles after passing around the distal edge of the TCL. Least common is the transligamentous pathway, in which the motor branch also separates from the median nerve within the carpal tunnel, but appears to perforate the TCL on its radial path to the thenar muscles, never reaching the distal aspect of the TCL. What is common is that all three variations occur on the radial side of the median nerve, as ultimately the motor branch travels to the thenar muscles on the radial side of the hand. The MANOS™ system includes an exacting hand-mapping technique, not dissimilar to that used for endoscopic surgery, that ensures the device is positioned safely; well ulnar to the median nerve and any variants of the motor branch.

What are the medical advantages of CTR performed with MANOS™?
There are several advantages to the MANOS™ Carpal Tunnel release system. For surgeons, benefits may include less prep time (no tourniquet or general anesthesia for example), less instrumentation needs, and less surgical time. Patients benefit from a short surgical time, the omission of general anesthetic, and most importantly the elimination of the palmar incision and the morbidity associated with it. MANOS™ reduces recovery time and virtually eliminates scarring, the need for physical therapy, splinting, and pillar pain.

What makes CTR with MANOS™ so innovative?
Very simply, it is the least invasive surgical treatment available for CTS, with surgical access measuring as little as 2mm. This advancement in carpal tunnel blade technology eliminates the need for a palmar incision and associated morbidity.