Ultrasound-Guided Carpal Tunnel Release Improves Long Term Outcomes

Ultrasound-guided carpal tunnel release (UGCTR) quickly improves hand function and reduces hand discomfort. UGCTR can be used as a safe, effective, and less invasive alternative to traditional open or endoscopic surgery.

The results are //published in the American Journal of Roentgenology (AJR).

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‘Minimally invasive ultrasound-guided carpal tunnel release (UGCTR) can be used as an effective alternative to open or endoscopic surgery. The system shows long-term efficacy as it improves function and discomfort in patients with carpal tunnel syndrome.’
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The researchers wanted to evaluate the long term efficacy of UGCTR in improving function and discomfort in carpal tunnel syndrome patients.

The researchers reviewed sixty-one UGCTR procedures performed in 46 patients (25 women and 21 men; mean age 60.6 years) with clinically diagnosed carpal tunnel syndrome.

All procedures were alsp performed under local anesthetic at an outpatient radiology office using the SX-One MicroKnife® (Sonex Health).

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"Patients answered three questionnaires (Quick-Disabilities of the Arm, Shoulder, and Hand [QDASH] and two parts of the Boston Carpal Tunnel Syndrome Questionnaire: symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS] scales) assessing the affected wrist's function and discomfort immediately pre-procedure, 2 weeks post-procedure, and at least one year post-procedure," said first author Sarah I. Kamel.

The median pre-procedure scores were:

45.4 – QDASH
3.2 - BCTSQ-SS
2.5 - BCTSQ-FS

The median 2- week post-procedure scores were:

22.5 – QDASH
1.7 - BCTSQ-SS
1.9 - BCTSQ-FS

All the values decreased (p < 0.001) from pre-procedure scores. They also surpassed reference standards for clinically important difference in scores.

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Follow-up questionnaires after 1.7 years post-procedure were obtained for 90% (55/61) of wrists. There were further declines (p < 0.001) in median scores: 2.3 for QDASH, 1.2 for BCTSQ-SS, and 1.1 for BCTSQ-FS.

At long-term follow-up, 96% (52/54) of wrists demonstrated lower QDASH, and 98% (53/54) lower BCTSQ (average of BCTSQ-SS and BCTSQ-FS), vs pre-procedure scores.

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There were no immediate post-operative complications. However, the authors included several response modifications for 2 patients who required surgery for complications experienced 8-10 days postoperatively (one for infection following injury and one for post-traumatic compartment syndrome).

The procedure includes a more extensive pre-procedural cleaning. It extends to the forearm circumferentially prior to draping.

A TegadermTM is now placed at the distal third of the forearm. It acts as an additional sterile barrier at the edge of the sterile field.

Two passes of the ligament transection are also performed routinely on patients in order to potentially reduce the risk of remnant tissue that may contribute to incomplete release.

Source-Medindia