Percutaneous Carpal Tunnel Release Research Articles

State of the art review. Complications after carpal tunnel release.

Carpal tunnel release (CTR) is the most performed surgery of the upper extremity. It is effective but not without complications. This state-of-the-art review covers most common intra- and postoperative complications after CTR. As endoscopic carpal tunnel release (ECTR) has developed over time, severe complications, such as nerve lesions, have diminished. ECTR still has a higher risk on transient nerve lesions. Open CTR on the other hand has a higher incidence of wound-related problems, including scar tenderness, irrespective of incision used. Most complications, such as pillar pain and infection, are ill-defined in the literature, leaving the exact incidence unknown and proposing challenges in treatment. The same is true for failure of treatment. Optimizing the length and location of incisions has played a vital role in reducing intra- and postoperative complications in CTR. It is expected that technical advances, such as ultrasound-guided percutaneous carpal tunnel release, will continue to play a role in the future.Level of evidence: V.

The Correlation of Carpal Tunnel Pressure with Clinical Outcomes following Ultrasonographically-Guided Percutaneous Carpal Tunnel Release.

Background: To evaluate the correlation between carpal tunnel pressure (CTP) and the clinical presentations, and to explore the possible predictors for the postoperative recovery pattern in patients with carpal tunnel syndrome (CTS). Materials and Methods: Consecutive patients with idiopathic CTS following percutaneous ultrasound-guided carpal tunnel release (UCTR) were enrolled. CTP was measured preoperatively and immediately after operation. The Boston Carpal Tunnel Questionnaire (BCTQ) and the cross-sectional area (CSA) of median nerve were recorded preoperatively and at 1, 3, and 12 months postoperatively. Results: 37 patients (37 hands; 8 men and 29 females; median age, 59.0 years) were enrolled. CTP significantly decreased immediately from 40.0 (28.0–58.0) to 13.0 (8.0–20.0) mmHg after UCTR. BCTQ scores significantly improved at 1 month postoperatively, and the improvement trend persisted until 12 months postoperatively (p < 0.001). Preoperative CTP was positively correlated with preoperative CSA and preoperative BCTQ scores (p < 0.05, all). Using group-based trajectory modeling, all patients were categorized into the “gradual recovery” or “fast recovery” group. Higher preoperative CTP was significantly associated with a faster recovery pattern (odds ratio: 1.32). Conclusions: Preoperative CTP was well correlated with the clinical presentations and might be a useful predictor for the postoperative clinical recovery pattern.

Cost-Effectiveness of Sonography-Guided Surgery.

Percutaneous carpal tunnel release (CTR) is a new surgical technique allowing to cut the transverse carpal ligament under sonography, without skin incision. The technique is safe, offers good functional results and early return to daily activities. This study investigates if percutaneous CTR is also cost-effective. Percutaneous CTR presents many advantages and may be safer than open and endoscopic CTR. This study could not demonstrate that it allows also cheaper surgery, at least as compared to open CTR. However, if it allows earlier return to work, percutaneous CTR could offer a major economic advantage over other techniques, particularly open surgery.

Safe Zones for Percutaneous Carpal Tunnel Release.

Carpal tunnel release (CTR) is an effective procedure used in open, endoscopic, or ultrasound-guided methods. The complications are rare but potentially devasting. Most complications come from errors related to intraoperative technique, especially in the minimally invasive approach. An understanding of the "safe zones" is essential to perform percutaneous CTR safely. This article reviews the anatomy of safe zones and the ultrasound-guided CTR (UCTR) techniques in an attempt to prevent intraoperative complications. In strict accordance with the concepts of safe zones, UCTR is an effective and reliable procedure. Substantial experience for ultrasound-guided injection and surgery is required.

Safety and Efficacy of Percutaneous Carpal Tunnel Release Versus Open Surgery

Safety and Efficacy of Percutaneous Carpal Tunnel Release Versus Open Surgery

Ultrasound-guided percutaneous carpal tunnel release in patients on hemodialysis: early experiences and clinical outcomes.

Purpose: The purpose of the current study was to evaluate the effectiveness of ultrasound-guided percutaneous carpal tunnel release in hemodialysis patients with carpal tunnel syndrome.Methods: From February 2009 to April 2013, a prospective review of 113 consecutive cases of ultrasound-guided percutaneous carpal tunnel release was carried out in 84 hemodialysis patients. Results were analyzed by clinical subjective scale, two self-administered questionnaires, and functional evaluations at seven time points (1 week and 1, 3, 6, 12, 18, and 24 months).Results: Satisfactory symptom improvement in patients was 82%, 80%, 86%, 89%, 90%, 91%, and 90% at 1 week and 1, 3, 6, 12, 18, and 24 months postoperatively, respectively. Moderate pain was suffered in 11.5% of patients within 1 week, 8.8% within 1 month, 2.7% within 3 months, and none after 12 months postoperatively. Static two-point discrimination and Semmes–Weinstein monofilament examinations presented significant improvements after 1 week and 1 month postoperatively and with time. Postoperative grip power demonstrated recovery and a significant increase after 3 and 6 months postoperatively. Three-jaw chuck-pinch strength showed significant increase after 1 month postoperatively. There were no operative complications.Conclusion: Ultrasound-guided percutaneous carpal tunnel release is an effective and safe procedure in hemodialysis patients with carpal tunnel syndrome. The advantages include a less invasive procedure, no tourniquet needed, only limited infiltration anesthesia, minimal soft-tissue exploration, and relatively short operation time. Our data suggest this technique can reliably relieve clinical symptoms, with early restoration of grip and pinch strength.

Percutaneous full endoscopic carpal tunnel release using a 5.9 mm endoscope

Objective To apply 5.9 mm whole cervical spine endoscopic system in the minimally invasive carpal tunnel release and evaluate its clinical effects, indications and safety. Methods A total of 11 patients with 14 sides of carpal tunnel syndrome were included in this study. There were 3 males and 8 females, with ages ranging from 36 to 56 years, with an average of 49 years. The right side was involved in 5 cases, left side in 3 cases and bilateral in 3 cases. Using the 5.9 mm endoscope cervical spine minimally invasive surgery system and bipolar radiofrequency, we accomplished percutaneous carpal tunnel release under local anesthesia. Three months after the surgery, Boston Carpal Tunnel Questionnaire (BCTQ), SF-36 and Disability of Arm, Shoulder and Hand (DASH) scores were used to evaluate the results. Results Pain symptoms disappeared entirely in all 11 patients. The nocturnal pain and numbness in 9 patients completely resolved. However, thenar atrophy persisted. The average postoperative DASH score was 13. The average BCTQ symptom severity score was 1.5, while the function grade was 1.5. Postoperative SF-36 scored 40 for the physical part and 57 for the mental part. Nine patients were satisfied with the outcomes, whereas two had a neutral response (neither satisfied nor dissatisfied). There were no postoperative infection, recurrence or neurovascular injuries. Conclusion Percutaneous 5.9 mm full-endoscope technology has advantages such as a smaller incision, a tourniquet-free technique, using local anesthesia, shorter operation time and faster postoperative recovery. These advantages warrant the development of a full endoscopic system dedicated to carpal tunnel release so the minimally invasive treatment of carpal tunnel syndrome will be safer and more effective. Key words: Carpal tunnel syndrome; Endoscopes; Surgical procedures,minimally invasive

Percutaneous Ultrasound-Guided Carpal Tunnel Release: Study Upon Clinical Efficacy and Safety

ObjectivesTo evaluate the feasibility and 6 months clinical result of sectioning of the transverse carpal ligament (TCL) and median nerve decompression after ultra-minimally invasive, ultrasound-guided percutaneous carpal tunnel release (PCTR) surgery.MethodsConsecutive patients with carpal tunnel syndrome were enrolled in this descriptive, open-label study. The procedure was performed in the interventional radiology room. Magnetic resonance imaging was performed at baseline and 1 month. The Boston Carpal Tunnel Questionnaire was administered at baseline, 1, and 6 months.Results129 patients were enrolled. Significant decreases in mean symptom severity scores (3.3 ± 0.7 at baseline, 1.7 ± 0.4 at Month 1, 1.3 ± 0.3 at Month 6) and mean functional status scores (2.6 ± 1.1 at baseline, 1.6 ± 0.4 at Month 1, 1.3 ± 0.5 at Month 6) were noted. Magnetic resonance imaging showed a complete section of all TCL and nerve decompression in 100% of patients. No complications were identified.ConclusionsUltrasound-guided PCTR was used successfully to section the TCL, decompress the median nerve, and reduce self-reported symptoms.

Ultrasonographically Guided Percutaneous Carpal Tunnel Release: Early Clinical Experiences and Outcomes

To present the technique and results of ultrasonographically guided percutaneous carpal tunnel release (PCTR) in a consecutive series of patients with carpal tunnel syndrome (CTS). We used previously defined landmarks with the "safe zones," localization, estimated size, and extent of the transverse carpal ligament (TCL) for this prospective clinical study of 91 consecutive cases of carpal tunnel release treated with this technique. The follow-up consisted of 4 time points (1week and 2, 6, and 12months) and a final evaluation at an average of 22.5months. The sensory disturbances disappeared in 76.8%, 93.4%, 100%, and 100% of the patients at 1week and 2, 6, and 12months postoperatively, respectively. Moderate pain was experienced in 24.2% of patients within 1week, in 6.6% of patients within 2months, and in 1.1% of patients within 12months after the operation. In the final evaluation, 2 hands were graded as unsatisfactory: one hand had moderate wrist pain without sensory disturbance, and one hand had a recurrence 14months after the operation. There were no intraoperative or postoperative complications. Ultrasonographically assisted PCTR is a safe and effective procedure, but it is technically demanding and requires substantial training to be proficient in its use. Level IV, therapeutic case series.

A Cadaveric and Preliminary Clinical Study of Ultrasonographically Assisted Percutaneous Carpal Tunnel Release

The aim of this study was to assess the effectiveness and safety profile of a new technique for ultrasonographically assisted percutaneous carpal tunnel release. Experiments were performed on 40 hands in 20 cadavers. We first performed a detailed ultrasonographic examination and correlation study that included surgical dissection of the transverse carpal ligament, the related neurovascular structures and the bony landmarks of the radiocarpal, midcarpal and carpometacarpal joints of the right hand. We then used the measurements we made for percutaneous carpal tunnel release of the transverse carpal ligament using intra-operative ultrasonography for guidance and a hook knife on the left-hand side. The completeness of the release and the potential risks of injury to the flexor tendon and neurovascular bundles were examined. Using real-time intra-operative ultrasonographic monitoring to clearly delineate these targets, we were able to percutaneously release the transverse carpal ligament completely in 18 (90%) of the 20 hands and partially release it in 2 without injuring any neurovascular bundles. We then performed the procedure on 91 consecutive cases of carpal tunnel syndrome and found that the sensory disturbances disappeared in 100% patients 12 mo post-operatively; only 2 hands were graded as unsatisfactory. There were no intra- or post-operative complications. Based on the results from the cadaveric studies and our successful preliminary clinical outcomes, we conclude that this method is tolerable and that its clinical application can be encouraged.

Percutaneous Carpal Tunnel Release Compared With Mini-Open Release Using Ultrasonographic Guidance for Both Techniques

To compare the outcomes of percutaneous carpal tunnel release (PCTR) and mini-open carpal tunnel release (mini-OCTR) using ultrasonographic guidance for both techniques. We included 74 hands of 65 women with idiopathic carpal tunnel syndrome (age, 52-71 y; mean, 58 y). Thirty-five hands of 29 women had the PCTR (release with a device consisting of an angled blade, guide, and holder, along a line midway between the median nerve and ulnar artery (safe line) under ultrasonography (incision, 4 mm), and 39 hands of 36 women had the mini-OCTR (release along the safe line, distally under direct vision (incision, 1-1.5 cm) and proximally under ultrasonography, using a device consisting of a basket punch and outer tube. Assessments at 3, 6, 13, 26, 52, and 104 weeks showed no significant differences in neurologic recovery between the groups (p > .05). The PCTR group had significantly less pain, greater grip and key-pinch strengths, and better satisfaction scores at 3 and 6 weeks (p < .05), and less scar sensitivity at 3, 6, and 13 weeks (p < .05). There were no complications. The PCTR provides the same neurologic recovery as does the mini-OCTR. The former leads to less postoperative morbidity and earlier functional return and achievement of satisfaction. Therapeutic III.

Sonographically Guided Percutaneous Carpal Tunnel Release

Minimally invasive techniques have become the standard of care for multiple procedures. This paper demonstrates both the surgeons' capacity to perform an accurate anatomic evaluation of the hand and forearm (n=10) and the use of this anatomic information to accurately perform sonographically guided, percutaneous carpal tunnel release using a single-portal endoscope without direct or indirect visualization in a cadaver model (n=6). Open dissection was then performed to confirm complete ligament transection and to evaluate the surrounding structures for injury. In all 6 cadavers, the transverse carpal ligament was transected completely without injury to any surrounding structures. With further investigation, this novel technique may offer a less invasive, office-based method for the surgical treatment of carpal tunnel syndrome that may offer patients an expedited recovery.

Percutaneous Carpal Tunnel Release Using Curved Hemostat and Meniscectomy Hook Knife

Purpose: The aims of this study were to introduce a method of percutaneous carpal tunnel release and report the results of our experience. Materials and Methods: A percutaneous carpal tunnel release was performed using a curved hemostat and a meniscectomy hook knife through a small transverse incision at the proximal wrist crease. Among 125 cases from 81 patients, 91 wrists from 58 patients were evaluated retrospectively in terms of the symptomatic resolution and complications. The mean follow up period was 38.9 months ranging from 12 to 118 months. Results: All but one cases (99%) showed a complete symptomatic resolution or a marked improvement postoperatively, and 94.5% of cases were satisfied with the final result. Two patients had a second operation, one chronic renal failure patient showed recurrent symptoms after an initial improvement and the other showed persistent symptoms. There were two superficial palmar arch injuries and one digital nerve injury. However two of them were the earliest cases of an inexperienced surgeons. Conclusion: When an experienced surgeon performs a percutaneous carpal tunnel release meticulously, it is a safe and reliable method with the benefits of less postoperative pain and an early recovery.

Endoscopy-assisted Percutaneous Carpal Tunnel Release through Single Small Incision

Endoscopy-assisted Percutaneous Carpal Tunnel Release through Single Small Incision