Wide-Awake Hand Surgery: Low Risk, High-Quality Results

Mary Jeannie Engling
Mary Jeannie Engling

Long before the pain in her fingers woke her from sleep, Mary “Jeannie” Engling knew it was past time to take care of the carpal tunnel syndrome that had plagued her for years. Similarly when the pain in Barbara Vilschick's trigger thumb no longer responded to steroid injections, she understood that surgery would be the inevitable next step.

Neither woman thought the procedures would be a cakewalk. Both were very pleasantly surprised. “It may be hard to believe, but it was a fun afternoon,” shares Jeannie. “I laughed and chatted with the nurses through the whole thing.” Barbara agrees. “Honestly, it wasn’t any different from getting my hair done,” she says, laughing.

The reason for these unanticipated reactions is a revolutionary advancement: wide-awake hand surgery. Orthopaedist Alison Kitay, MD, chief of hand surgery at MedStar Montgomery Medical Center, part of the MedStar Orthopaedic Institute, the area’s largest and most experienced team of orthopaedic surgeons, calls the technique a real boon for treatment of these two common problems.

“With these small procedures, we can avoid the risks of anesthesia and sedation by simply numbing the area,” says Dr. Kitay. “Surgery can take just 10 minutes, and after some cheese and crackers, patients can drive themselves home. It’s the biggest change in hand surgery in the last decade, and a huge boost that improves patients’ quality of life.”

Raising the Roof on Carpal Tunnel

For Jeannie, numbness and tingling in three fingers in both hands had been troubling her for years. Yet she was hesitant to have surgery. “I was hesitant about anesthesia,” she says. “But then a friend encouraged me to go to a lecture Dr. Kitay was giving in the community. She dragged me there—and I’m so glad she did.” Jeannie is back to gardening after the minimally invasive procedure that took care of her carpal tunnel syndrome.

Jeannie’s symptoms resulted from the compression of the median nerve that runs from the forearm to the hand through a passageway called the carpal tunnel. In carpal tunnel syndrome, the passageway narrows because of inflammation, arthritis or fluid build-up. Patients experience pain and numbness. 

During Jeannie’s procedure, Dr. Kitay made a small incision and released the tunnel “roof” to provide more room for the nerve—and then closed the incision with a few stitches.

“I had very little pain and was back to normal activities right away. I’m going to have the other hand done soon!” says Jeannie.

Barbara Vilschick
Barbara Vilschick

Trigger Thumb Released

On Barbara’s first visit with Dr. Kitay, she gave her a steroid injection—routine treatment for trigger finger. But when stiffness in her thumb persisted, locking it into a bent position, Barbara decided to have surgery.

During the procedure, Dr. Kitay made a small incision at the base of the thumb and released the pulley—a structure around the tendon that allows the fingers to flex. In trigger thumb, the pulley becomes irritated and interferes with the gliding motion of the tendon. 

“I went to MedStar Montgomery around two in the afternoon and was home by five,” Barbara says. “I took some over-the-counter pain medication just in case—but there was no pain. I have to say, it was a much easier experience than I imagined.”

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Like Jeannie and Barbara, patients marvel at how simple the surgical experience is for them—and how quickly they recover.
- Alison Kitay, MD, Chief of Hand Surgery at
MedStar Montgomery Medical Center