Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Clinical Outcomes in Carpal Tunnel Syndrome

2020 ◽  
Author(s):  
Sarah I Kamel ◽  
Bradley Freid ◽  
Corbin Pomeranz ◽  
Ethan J Halpern ◽  
Levon N Nazarian
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Ultrasound Guided ◽  
Tunnel Syndrome

scholarly journals Ultrasound Guided Transverse Carpal Ligament Fenestration for Carpal Tunnel Syndrome: A Case Series

2018 ◽  
pp. 19-26
Author(s):  
Yu M. Chiu
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Local Anesthesia ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Case Series ◽  
Transverse Carpal Ligament ◽  
Ultrasound Guided ◽  
Tunnel Syndrome

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

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

2018 ◽  
Vol 35 (04) ◽  
pp. 248-254 ◽  
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.

scholarly journals Relationship between clinical outcomes and nerve conduction studies before and after surgery in patients with carpal tunnel syndrome

2021 ◽  
Author(s):  
Masato Ise ◽  
Taichi Saito ◽  
Yoshimi Katayama ◽  
Ryuichi Nakahara ◽  
Yasunori Shimamura ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Clinical Outcomes ◽  
Carpal Tunnel ◽  
Nerve Conduction ◽  
Carpal Tunnel Release ◽  
Characteristic Curve ◽  
Objective Assessment ◽  
Cutoff Score ◽  
Tunnel Syndrome

Abstract Background:Nerve conduction study (NCS) is the only useful test for objective assessment of carpal tunnel syndrome (CTS). However, the relationship between pre- and postoperative NCS and clinical outcomes was unclear. This study aimed to determine whether pre- and postoperative (6 months) NCS could predict patient-oriented and motor outcomes (6 and 12 months postoperatively) in patients with CTS.Methods:Of the 85 patients with CTS, 107 hands were analyzed from March 2011 to March 2020. All patients underwent open carpal tunnel release and were examined using the disabilities of the arm, shoulder and hand (DASH) questionnaire and grip strength (GS) preoperatively and 6 and 12 months. Moreover, NCS was examined preoperatively and 6 months postoperatively. Distal motor latency (DML) and sensory conduction velocity (SCV) were the parameters used for NCS. The correlation coefficient between NCS and DASH or GS was calculated. A receiver operating characteristic curve was utilized to determine the NCS threshold value to predict DASH and GS improvement.Results:The average scores of GS preoperatively and 6 and 12 months postoperatively were 21.3, 22.3, and 22.8, respectively. On the other hand, the average scores of DASH preoperatively and 6 and 12 months postoperatively were 28.8, 18.3, and 12.2, respectively. The average NCS scores (DML and SCV) preoperatively/6 months postoperatively were 7.3/5.4 and 27.8/36.7, respectively. Preoperative NCS did not correlate with DASH and GS. Postoperative SCV correlated with the change in grip strength (6–12 months, r = 0.67; 0–12 months, r = 0.60) and DASH (0–12 months, r = 0.77). Moreover, postoperative DML correlated with the change in DASH (6–12 months, r = -0.33; 0–12 months, r = -0.59). The prediction for the improvement of GS/DASH achieved a sensitivity of 50.0%/66.7% and a specificity of 100%/100%, at an SCV cutoff score of 38.5/45.0 or above. The prediction for improvement of GS/DASH achieved a sensitivity of 83.3%/66.7% and a specificity of 100%/66.7% at a DML cutoff score of 4.4/4.4 or below.Conclusions:NCS at 6 months postoperatively can be used to predict the improvement of clinical outcome after 6 months postoperatively in patients with CTS.

scholarly journals ‘INSIGHT-PRECISION’: a new, mini-invasive technique for the surgical treatment of carpal tunnel syndrome

2019 ◽  
Vol 48 (1) ◽  
pp. 030006051987808
Author(s):  
José Dinis Carmo
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Surgical Technique ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Invasive Technique ◽  
Electrodiagnostic Testing ◽  
Surgical Tool ◽  
Tunnel Syndrome

Objective To describe a new mini-invasive surgical technique for carpal tunnel release and to present clinical findings associated with using this technique. Methods Patients with idiopathic carpal tunnel syndrome without prior surgical treatment, who underwent a new minimally-invasive surgical technique using a specific surgical tool-kit developed by the author, were included. Prospective data were collected, including preoperative electrodiagnostic testing. The subjective condition of all patients was evaluated pre- and postoperatively with a five-level Likert-type scale (LS) and muscular strength was tested using a JAMAR dynamometer and pinch gauge. Results A total of 116 patients (157 hands/cases) underwent surgery performed by the author, and were followed for a mean of 40 months (range, 6 months–7 years). Of these, preoperative electrodiagnostic testing was performed in 112 patients (96.6%). No significant complications were reported. By three months, patients reported that they were satisfied or very satisfied in 147/149 cases (98.7%; LS grade I and II). Strength recovery at three months, based on the average of four measures, was 99.17% (range, 97.43–100.97%). Conclusions The described technique is minimally invasive, safe and simple to perform, and provides good results.

Transillumination in minimally invasive surgery for carpal tunnel release

1996 ◽  
Vol 85 (6) ◽  
pp. 1184-1186 ◽  
Author(s):  
Angelo Franzini ◽  
Giovanni Broggi ◽  
Domenico Servello ◽  
Ivano Dones ◽  
Maria Grazia Pluchino
Keyword(s):  
Minimally Invasive Surgery ◽  
Carpal Tunnel Syndrome ◽  
Minimally Invasive ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Alternative Technique ◽  
Content Type ◽  
Operative Results ◽  
Tunnel Syndrome ◽  
Fine Print

✓ An alternative technique for performing minimally invasive release of carpal tunnel syndrome is described. The suggested methodology is based on transillumination of the carpal tunnel during surgery. The advantages of the technique are discussed and compared with other available surgical procedures including endoscopy. The authors also describe preliminary operative results in 50 consecutive patients.

scholarly journals Does Carpal Tunnel Release Provide Long-Term Relief in Patients with Hemodialysis-Associated Carpal Tunnel Syndrome?

2012 ◽  
Vol 470 (9) ◽  
pp. 2561-2565 ◽  
Author(s):  
Ho Jung Kang ◽  
Il Hyun Koh ◽  
Won Yong Lee ◽  
Yun Rak Choi ◽  
Soo Bong Hahn
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Tunnel Syndrome

Long-Term Results of Carpal Tunnel Release

1995 ◽  
Vol 20 (4) ◽  
pp. 470-474 ◽  
Author(s):  
M. P. NANCOLLAS ◽  
C. A. PEIMER ◽  
D. R. WHEELER ◽  
F. S. SHERWIN
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Long Term Results ◽  
Significant Morbidity ◽  
Surgical Scar ◽  
Internal Neurolysis ◽  
Maximum Improvement ◽  
Tunnel Syndrome

To determine the long-term results of carpal tunnel release, we retrospectively reviewed 60 cases, an average of 5.5 years after surgery. 87% reported a good or excellent overall outcome; the average time to maximum improvement of symptoms was 9.8 months. However, 30% reported poor to fair strength and long-term scar discomfort, and 57% noted a return of some pre-operative symptoms, most commonly pain, beginning an average of 2 years after surgery. We found no correlation between pre-operative symptoms or extent of surgical dissection (internal neurolysis) and outcome. Carpal tunnel syndrome was job related in 42%; of these, 26% changed from heavy to lighter work following surgery. Although occupational cases were slower to improve and remained off work longer, the long-term subjective results were the same for both groups. We found significant morbidity from the surgical scar and decreased strength, and often considerable delay until ultimate improvement, especially in patients with job-related carpal tunnel syndrome.

Sign in / Sign up

Export Citation Format

Share Document