Ultrasound-Guided Minimal Invasive Carpal Tunnel Release: An Optimized Algorithm.

Abstract

PURPOSE:

To present a safety-optimized ultrasound-guided minimal invasive carpal tunnel release (CTR) procedure.

MATERIALS AND METHODS:

104 patients (67 female, 37 male; mean age 60.6 ± 14.3 years, 95% CI 57.9 to 63.4 years) with clinical and electrophysiological verified typical carpal tunnel syndrome were referred for a high-resolution ultrasound of the median nerve and were then consecutively assigned for an ultrasound-guided CTR after exclusion of possible secondary causes of carpal tunnel syndrome such as tumors, tendovaginitis, ganglia and possible contraindications (e.g., crossing collateral vessels, nerve variations). Applying a newly adapted and optimized algorithm, basing on the work proposed by Petrover et al. CTR was performed using a button tip cannula which has several safety advantages: On the one hand, the button tip cannula acts as a blunt and atraumatic guiding splint for the subsequent insertion of the hook-knife, and on the other hands, it serves as a "hydro-inflation"-tool, i.e., a fluid-based expansion of the working-space is warranted during the whole procedure whenever needed.

RESULTS:

In all patients, successful releases were confirmed by the depiction of a completely transected transverse carpal ligament during and in the postoperative ultrasound-controls two weeks after intervention. All patients reported markedly reduction of symptoms promptly after this safety-optimized ultrasound-guided minimal invasive CTR and at the follow-up examination. No complications were evident.

CONCLUSION:

The here proposed optimized algorithm assures a reliable and safe ultrasound-guided CTR and thus should be taken into account for this minimal invasive interventional procedure.

• Authors: Alexander Loizides, Sarah Honold, Elisabeth Skalla-Oberherber, Leonhard Gruber, Wolfgang Löscher, Bernhard Moriggl, Marko Konschake, Hannes Gruber
• Journal: Cardiovascular and interventional radiology (Cardiovasc Intervent Radiol) Vol. 44 Issue 6 Pg. 976-981 (Jun 2021) ISSN: 1432-086X [Electronic] United States
• PMID: 33629135 (Publication Type: Journal Article)

Topics

• Algorithms
• Carpal Tunnel Syndrome (surgery)
• Female
• Humans
• Image Interpretation, Computer-Assisted (methods)
• Male
• Median Nerve (diagnostic imaging)
• Middle Aged
• Minimally Invasive Surgical Procedures (methods)
• Treatment Outcome
• Ultrasonography, Interventional (methods)