Ultrasound-guided percutaneous carpal tunnel release: 2-year follow-up of 641 hands

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

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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.

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Combined Cubital and Carpal Tunnel Release Results in Symptom Resolution Outside of the Median or Ulnar Nerve Distributions

The Open Orthopaedics Journal ◽

10.2174/1874325001610010111 ◽

2016 ◽

Vol 10 (1) ◽

pp. 111-119 ◽

Cited By ~ 1

Author(s):

Peter C. Chimenti ◽

Allison W. McIntyre ◽

Sean M. Childs ◽

Warren C. Hammert ◽

John C. Elfar

Keyword(s):

Median Nerve ◽

Ulnar Nerve ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Symptomatic Improvement ◽

Patient Counseling ◽

Symptom Resolution ◽

Persistent Symptoms ◽

Validated Questionnaires

Background: Resolution of symptoms including pain, numbness, and tingling outside of the median nerve distribution has been shown to occur following carpal tunnel release. We hypothesized that a similar effect would be found after combined release of the ulnar nerve at the elbow with simultaneous release of the median nerve at the carpal tunnel. Methods: 20 patients with combined cubital and carpal tunnel syndrome were prospectively enrolled. The upper extremity was divided into six zones and the location of pain, numbness, tingling, or strange sensations was recorded pre-operatively. Two-point discrimination, Semmes-Weinstein monofilament testing, and validated questionnaires were collected pre-operatively and at six-week follow-up. Results: Probability of resolution was greater in the median nerve distribution than the ulnar nerve for numbness (71% vs. 43%), tingling (86% vs. 75%). Seventy percent of the cohort reported at least one extra-anatomic symptom pre-operatively, and greater than 80% of these resolved at early follow-up. There was a decrease in pain as measured by validated questionnaires. Conclusion: This study documents resolution of symptoms in both extra-ulnar and extra-median distributions after combined cubital and carpal tunnel release. Pre-operative patient counseling may therefore include the likelihood of symptomatic improvement in a non-expected nerve distribution after this procedure, assuming no other concomitant pathology which may cause persistent symptoms. Future studies could be directed at correlating pre-operative disease severity with probability of symptom resolution using a larger population.

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Efficacy of ultrasound-guided forearm nerve block versus forearm intravenous regional anaesthesia in patients undergoing carpal tunnel release: A randomized controlled trial

PLoS ONE ◽

10.1371/journal.pone.0246863 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246863

Author(s):

Hassanin Jalil ◽

Florence Polfliet ◽

Kristof Nijs ◽

Liesbeth Bruckers ◽

Gerrit De Wachter ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Intensity ◽

Nerve Block ◽

Carpal Tunnel ◽

Regional Anaesthesia ◽

Carpal Tunnel Release ◽

Ultrasound Guided ◽

Surgical Time ◽

Randomized Controlled ◽

Intravenous Regional Anaesthesia

Background and objectives Distal upper extremity surgery is commonly performed under regional anaesthesia, including intravenous regional anaesthesia (IVRA) and ultrasound-guided forearm nerve block. This study aimed to investigate if ultrasound-guided forearm nerve block is superior to forearm IVRA in producing a surgical block in patients undergoing carpal tunnel release. Methods In this observer-blinded, randomized controlled superiority trial, 100 patients undergoing carpal tunnel release were randomized to receive ultrasound-guided forearm nerve block (n = 50) or forearm IVRA (n = 50). The primary outcome was anaesthetic efficacy evaluated by classifying the blocks as complete vs incomplete. Complete anaesthesia was defined as total sensory block, incomplete anaesthesia as mild pain requiring more analgesics or need of general anaesthesia. Pain intensity on a numeric rating scale (0–10) was recorded. Surgeon satisfaction with hemostasis, surgical time, and OR stay time were recorded. Patient satisfaction with the quality of the block was assessed at POD 1. Results In total, 43 (86%) of the forearm nerve blocks were evaluated as complete, compared to 33 (66%) of the forearm IVRA (p = 0.019). After the forearm nerve block, pain intensity was lower at discharge (-1.76 points lower, 95% CI (-2.92, -0.59), p = 0.0006) compared to patients treated with forearm IVRA. No differences in pain experienced at the start of the surgery, during surgery, and at POD1, nor in surgical time or total OR stay were observed between groups. Surgeon (p = 0.0016) and patient satisfaction (p = 0.0023) were slightly higher after forearm nerve block. Conclusion An ultrasound-guided forearm nerve block is superior compared to forearm IVRA in providing a surgical block in patients undergoing carpal tunnel release. Trial registration This trial was registered as NCT03411551.

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The Results of Carpal Tunnel Release: Open Versus Endoscopic Technique

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90039-6 ◽

1994 ◽

Vol 19 (1) ◽

pp. 14-17 ◽

Cited By ~ 68

Author(s):

S. BANDE ◽

L. DE SMET ◽

G. FABRY

Keyword(s):

Patient Satisfaction ◽

Return To Work ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Endoscopic Technique ◽

Open Release ◽

Significant Difference ◽

Open Versus ◽

Portal Technique

We retrospectively compared two similar groups of patients who underwent either endoscopic decompression of the carpal tunnel (single portal technique, 44 patients) or open decompression (58 patients) during 1 year in our department. To find out whether there was any subjective difference between the results of the two techniques, we sent each patient a questionnaire and received a 95% response. No major complications occurred. Three endoscopic decompressions had to be abandoned, and open release was performed. We could not demonstrate any significant difference in relief of symptoms and return to work between the two groups. Patient satisfaction at 6 to 18 months follow-up was high with both techniques.

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An Assessment of Sleep Disturbance in Patients before and after Carpal Tunnel Release

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835519500188 ◽

2019 ◽

Vol 24 (02) ◽

pp. 144-146 ◽

Cited By ~ 1

Author(s):

John Erickson ◽

Daniel Polatsch ◽

Steven Beldner ◽

Eitan Melamed

Keyword(s):

Sleep Quality ◽

Sleep Disturbance ◽

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Continuous Variables ◽

Night Time ◽

Before And After ◽

Tunnel Syndrome ◽

English Speaking

Background: Night time numbness is a key characteristic of CTS and relief of night time symptoms is one of the outcomes most important to patients. This study tested the null hypothesis that there is no difference between sleep quality and night symptoms before and after carpal tunnel release (CTR). Methods: Forty-four, English-speaking adult patients requesting open CTR for electrodiagnostically confirmed carpal tunnel syndrome completed questionnaires before and after surgery. Average age was 59, 24 patients were men and 20 were women. Patient with a primary or secondary sleep disorder were excluded. Before surgery, patients completed the Pittsburg Sleep Quality index (PSQI). At an average of 3 months after surgery, participants completed PSQI questionnaires. Onset of sleep quality improvement was specifically addressed. Differences between preoperative and postoperative sleep quality were evaluated using the paired t-test. Spearman correlations were used to assess the relationship between continuous variables. Results: Of the 44 patients, 32 (72%) were classified as poor sleepers (PSQI > 5.5) prior to surgery. At 3 months follow up, there was a significant improvement PSQI global scores (7.8 ± 5.1 vs 4 ± 3.5, p < 0.001) as well as subdivisions. Daytime dysfunction (0.2 ± 0.4, p < 0.001) and medication use (1.0 ± 1.2 vs 0.9 ± 1.2, p < 0.045) secondary to sleep disturbance and was improved as well. In all patients, onset of improvement was within 24 hours of surgery. Conclusions: CTR is associated with improvement in sleep quality at 3 months follow-up. CTR improves daytime dysfunction related to the sleep disturbance. The onset of sleep improvement is 24 hours after surgery in most cases.

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Comparison of Local-Only Anesthesia Versus Sedation in Patients Undergoing Staged Bilateral Carpal Tunnel Release: A Randomized Trial

Hand ◽

10.1177/1558944719836237 ◽

2019 ◽

Vol 15 (6) ◽

pp. 785-792 ◽

Cited By ~ 1

Author(s):

Garrhett G. Via ◽

Andrew R. Esterle ◽

Hisham M. Awan ◽

Sonu A. Jain ◽

Kanu S. Goyal

Keyword(s):

Carpal Tunnel ◽

Carpal Tunnel Release ◽

Common Disease ◽

Hand Laterality ◽

Included Patient ◽

High Satisfaction ◽

Tunnel Syndrome ◽

Second Procedure ◽

Wide Awake

Purpose: Carpal tunnel syndrome is a common disease treated operatively. During the operation, the patient may be wide-awake or sedated. The current literature has only compared separate cohorts. We sought to compare patient experience with both local-only anesthesia and sedation. Methods: Staged bilateral carpal tunnel release utilizing open or endoscopic technique was scheduled and followed through to completion of per-protocol analysis in 31 patients. Patients chose initial hand laterality and were randomized regarding initial anesthesia method: local-only or sedation. Data collection via questionnaires began at consent and continued to 6 weeks postoperatively from second procedure. Primary outcome measures included patient satisfaction and patient anesthesia preference. Results: At final follow-up, 6 weeks postoperatively, high satisfaction (30 of 31 patients per method) was reported with both types of anesthesia. Among these patients, 17 (54%) preferred local-only anesthesia, 10 (34%) preferred sedation, 2 had no preference, and 2 opted out of response. Although anesthesia fees were approximately $390 lower with local-only anesthesia, total costs for carpal tunnel release were not significantly different with respect to the anesthesia cohorts. Total time in surgical facility was approximately 26 minutes quicker with local-only anesthesia, largely due to shorter time in the post-anesthesia care unit. Scaled comparison of worst postoperative pain following the 2 procedures revealed no difference between local-only anesthesia and sedation. Conclusions: Patients reported equal satisfaction scores with carpal tunnel release whether performed under local-only anesthesia or with sedation. In addition, local-only anesthesia was indicated as the preference of patients in 59% of cases.

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Outcome of Carpal Tunnel Release in Diabetic Patients

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90131-7 ◽

1994 ◽

Vol 19 (5) ◽

pp. 626-629 ◽

Cited By ~ 23

Author(s):

M. M. AL-QATTAN ◽

R. T. MANKTELOW ◽

C. V. A. BOWEN

Keyword(s):

Retrospective Study ◽

Peripheral Neuropathy ◽

Carpal Tunnel ◽

Nerve Conduction ◽

Complete Resolution ◽

Carpal Tunnel Release ◽

Nerve Conduction Studies ◽

Diabetic Patients ◽

Hand Symptoms

A retrospective study of 15 diabetic patients (20 hands), who underwent carpal tunnel release, was performed to determine the outcome. All patients had a minimum of 18 months of follow-up. Outcome was considered excellent if there was complete resolution of symptoms and this occurred in 35% of the treated hands. Eight hands (40%) had a good outcome with significant improvement of pre-operative symptoms. Outcome was considered poor when symptoms were minimally improved, unchanged, or worse after surgery and this occurred in 25% of treated hands. All hands with a poor final result had either no electrodiagnostic evidence of localized compression or only mild compression in pre-operative nerve conduction studies. It was postulated that the contribution of localized compression to pre-operative hand symptoms was less than the contribution of peripheral neuropathy in these hands.

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