Poster 262 Ultrasound Guided Fenestration Without or With a Small Dose of Steroid Injection for Treating Moderate Carpal Tunnel Syndrome: A Case Series Study

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

Download Full-text

1287 A Comparison of Surgical Decompression and Steroid Injections to Treat Carpal Tunnel Syndrome: A Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab259.831 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

F La Costa

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Steroid Injection ◽

Muscular Atrophy ◽

Meta Analysis ◽

Surgical Decompression ◽

Optimal Treatment ◽

Post Treatment ◽

Entrapment Neuropathies ◽

Tunnel Syndrome

Abstract Introduction Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. It accounts for 90% of all entrapment neuropathies, with a 7-16% in the UK. It has a significant impact on patients’ daily lives. Clinically, CTS results in paraesthesia, while extreme cases may involve muscular atrophy and weakness. There is currently a disparity between optimal treatments for CTS. Therefore, this paper aims to identify the optimal treatment for CTS with post-treatment BCTQ (Boston Carpal Tunnel Questionnaire) scores (including both functional and symptomatic severity) at 1, 3 and 6 months. Method The BCTQ scores for were sited from PubMed, Google Scholar and the University of Dundee Library search engine by entering key words such as “carpal tunnel syndrome”, “surgical decompression”, “surgical release” and “steroid injection”. Means and standard deviations for pre- and post-treatment after 1, 3 and 6 months were obtained. From this, forest plots were constructed using a software where steroid injection and surgical decompression were inputted separately, and effect sizes were then compared for 1, 3 and 6 months. Results The meta-analysis included reviewing 133 articles. The effect size was determined using the random effects model. Steroid injection was more effective than surgical decompression after 1 and 3 months. However, after 6 months, surgical decompression was more effective. Conclusions Identification of long-term relief of CTS through surgical decompression allows the reduction of symptom recurrence and thus costly follow-up appointments. This study provides robust clinical findings for the optimal treatment of CTS.

Download Full-text

Ultrasound-Guided Surgery for Carpal Tunnel Syndrome: A New Interventional Procedure

Seminars in Interventional Radiology ◽

10.1055/s-0038-1673360 ◽

2018 ◽

Vol 35 (04) ◽

pp. 248-254 ◽

Cited By ~ 3

Author(s):

Antoine Hakime ◽

Jonathan Silvera ◽

Pascal Richette ◽

Rémy Nizard ◽

David Petrover

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Interventional Procedure ◽

Carpal Tunnel Release ◽

Ultrasound Guided ◽

Recent Contribution ◽

Invasive Approach ◽

Guided Surgery ◽

Tunnel Syndrome ◽

Meta Analyses

AbstractCarpal tunnel syndrome (CTS) may be treated surgically if medical treatment fails. The classical approach involves release of the flexor retinaculum by endoscopic or open surgery. Meta-analyses have shown that the risk of nerve injury may be higher with endoscopic treatment. The recent contribution of ultrasound to the diagnosis and therapeutic management of CTS opens new perspectives. Ultrasound-guided carpal tunnel release via a minimally invasive approach enables the whole operation to be performed as a percutaneous radiological procedure. The advantages are a smaller incision compared with classical techniques; great safety during the procedure by visualization of anatomic structures, particularly variations in the median nerve; and realization of the procedure under local anesthesia. These advantages lead to a reduction in postsurgical sequelae and more rapid resumption of daily activities and work. Dressings are removed by the third day postsurgery. Recent studies seem to confirm the medical, economic, and aesthetic benefits of this new approach.

Download Full-text

Ultrasound-guided percutaneous surgery for carpal tunnel syndrome: A cadaver study

Joint Bone Spine ◽

10.1016/j.jbspin.2010.12.006 ◽

2011 ◽

Vol 78 (5) ◽

pp. 516-518 ◽

Cited By ~ 28

Author(s):

Bertrand Lecoq ◽

Nathalie Hanouz ◽

Claude Vielpeau ◽

Christian Marcelli

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Cadaver Study ◽

Percutaneous Surgery ◽

Ultrasound Guided ◽

Tunnel Syndrome

Download Full-text

PROFILE OF PATIENTS WITH CARPAL TUNNEL SYNDROME TREATED AT A REFERRAL SERVICE

Acta Ortopédica Brasileira ◽

10.1590/1413-785220202803227138 ◽

2020 ◽

Vol 28 (3) ◽

pp. 117-120

Author(s):

HENVER RIBEIRO DE PAIVA FILHO ◽

VALDÊNIA DAS GRAÇAS NASCIMENTO PAIVA ◽

ELIAS FELIX DE OLIVEIRA ◽

MURILO ANTÔNIO ROCHA

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Case Series ◽

Hand Surgery ◽

Elementary Level ◽

Level Of Evidence ◽

Women Smokers ◽

Referral Service ◽

Tunnel Syndrome ◽

Epidemiological Characteristics

ABSTRACT Objective: To describe the clinical and epidemiological characteristics of people diagnosed with carpal tunnel syndrome (CTS) treated at a hand surgery outpatient clinic of a regional referral service. Methods: Interview and specific medical examination of 150 people diagnosed with CTS underwent, and statistical analysis of the results obtained. Results: Women smokers, in the fifth decade of life, married, overweight and educated until the elementary level prevailed in our study. Arterial hypertension and diabetes were the most reported comorbidities, and Durkan’s test was the most prevalent. Conclusion: CTS is prevalent in women in their fifth decade of life, with bilateral involvement and high school. The hypertension and diabetes are the most common diseases in people with CTS. Level of evidence IV, Case series.

Download Full-text