This case involves a patient who underwent surgery to address carpal tunnel syndrome derived from amyloid polyneuropathy. The physician used a recently developed device to assist with the surgery which failed, at which point another device was employed and the procedure was completed. It was documented that there were no complications during the procedure. Some time later the patient returned to the orthopedic surgeon for a follow-up visit, at which point she was again told that there had been no complications. Despite this, the patient expressed complaints of numbness in some of her fingers. The patient continued to present for follow-up over the next few months, during which time she claimed that the numbness persisted. Eventually, the patient underwent more aggressive testing, which indicated a laceration of a major nerve in her hand. Despite multiple treatments, the patient continued to suffer from ongoing and debilitating numbness in her hand.
Question(s) For Expert Witness
- 1. Are you familiar with / do you routinely use this device?
- 2. What are the risks for nerve damage in a carpal tunnel operation performed with this device as opposed to other devices?
Expert Witness Response E-051736
I am familiar with the Manos device – it is a device that is used to perform a percutaneous carpal tunnel release (CTR). The most common means of CTR is an open surgery, followed by endoscopic release. The Manos uses either ultrasound or nerve stimulation guidance to perform the release. I do not use the device because I believe the safety of it is questionable due to the lack of direct visualization. In my opinion, the risks associated with this mode of carpal tunnel release is greater than with open or visualization techniques. The potential injuries include injury to the median nerve or the superficial palmar arch (artery). I have not been sued or arrested.
Expert Witness Response E-006761
I am familiar with the Manos device having used it in the past for my Carpal Tunnel patients. Currently, I do mini-open carpal tunnel release procedures to treat carpal tunnel syndrome. I have performed over 5000 cases using various different forms of devices. The most common complication in a surgery performed with the Manos device, and most endoscopic devices, is incomplete release and the second is nerve laceration. This is one of the major reasons I refrain from using the device.