A day observing
Orthopaedic surgeon Dr John Mison spent a day observing in theatre, during which several endoscopic carpal tunnel releases and arthroscopic rotator cuff repairs were performed.
Why surgeons spend a day in a colleague's theatre
Visits of this kind are a normal part of surgical practice. A surgeon who is already qualified and in practice arranges to spend a day with a colleague to see how a particular operation is done: the positioning of the patient, the sequence of steps, the instruments chosen, and the decisions taken when the anatomy is not quite as expected. Very little of that transfers onto paper, which is why it is watched rather than read about. The visiting surgeon observes and does not operate, and patients are asked beforehand.
Endoscopic carpal tunnel release
Carpal tunnel syndrome is compression of the median nerve where it passes through a tunnel at the front of the wrist, underneath a tight band of tissue called the transverse carpal ligament. It causes numbness, tingling and pain in the hand, often worst at night, and over time weakness of the thumb. A release divides that band so the nerve has more room.
Done endoscopically, the ligament is divided from inside the tunnel through one or two small incisions using a camera, rather than through a longer incision across the palm. Whether that approach is suitable depends on the individual, and non-surgical measures such as splinting are often tried first. Individual results vary.
Arthroscopic rotator cuff repair
The rotator cuff is the group of four tendons that hold the ball of the shoulder in its socket and rotate the arm. When one of them tears away from the bone the shoulder can become painful and weak, particularly on reaching overhead and lifting, and the pain is often worse at night.
An arthroscopic repair reattaches the torn tendon to its footprint on the bone through keyhole portals, using anchors placed in the bone and sutures passed through the tendon. The tendon then has to heal back onto bone, which is why a period of protection and a staged return to movement follows the operation. Not every tear needs repairing, and the decision rests on the size and position of the tear, the symptoms and what the person needs the arm to do. Individual results vary.
Related information
- Our rotator cuff repair and rotator cuff tear pages
- Our shoulder surgery page
- Our rehabilitation page