Carpal tunnel syndrome is caused by compression of
the median nerve under the transverse carpal ligament.
We present a description of an ultrasound-guided
(USG) percutaneous technique of the transcarpal tunnel
and provide a discussion to the evidence in utilizing
a minimally invasive technique as an alternative
to open and endoscopic carpal tunnel release.
USG percutaneous transverse carpal ligament fenestration
is a quick, and relatively simple office based
treatment for carpal tunnel syndrome. The use of
ultrasound provides satisfactory visualization for the
procedure and requires very little time and effort for
setup. Here, in this case series, we detail the procedure
and the results from our follow-up.
This report details a case series of 2 patients with
confirmed electrodiagnostic findings of mild to severe
median neuropathy at the wrist in a university
hospital outpatient pain management center. USG
percutaneous fenestration of the transcarpal ligament
was performed under local anesthesia. Patients were
followed up from 4 to 20 weeks.
It was found in patient 1, a greater than 60% reduction
in pain at 20 weeks follow-up, and patient 2 had
at least 50% reduction in pain at 8 weeks follow-up.
Both patients had a minimum of 50% improvement in
pain and sensory disturbance and without any adverse
events.
The main advantage of USG transverse carpal ligament
fenestration is that it is an office based procedure,
requiring local anesthesia only. Minimally invasive
USG transcarpal ligament fenestration, in select patients,
may be an appropriate tool and even prove to
be a surgery-sparing modality. The limitations of this
study includes no case-control, small sample size, and
the short term follow-up. In conclusion, this case series
presents an alternative to a more invasive and costlier
procedure including open and endoscopic carpal tunnel
release, usually performed in a surgical suite. USG
percutaneous transverse carpal ligament fenestration is
a quick, and relatively simple office based treatment for
carpal tunnel syndrome. The use of ultrasound provides
satisfactory visualization for the procedure and requires
very little time and effort for setup.
Key words: Ultrasound guided, transverse carpal ligament,
fenestration, carpal tunnel syndrome