Ultrasound-assisted surgical release of carpal tunnel syndrome: Results of a pilot open-label uncontrolled trial conducted outside the operating theatre.

OBJECTIVE: To confirm the feasibility of ultrasound-assisted surgical release of carpal tunnel syndrome in the interventional radiology room. MATERIALS AND METHODS: Study involving 39 patients suffering from carpal tunnel syndrome confirmed by electromyogram and unresponsive to medical treatment. The patients were recruited via orthopedic surgery and rheumatology consultations and were operated on in the interventional radiology room under local anesthesia. A single approach was used, at the wrist flexion crease. Patients were monitored over a 90-day period. This is a descriptive open-label uncontrolled study. RESULTS: Fifteen men and 24 women, aged between 21 and 86 years, were included, 23 of whom were in work. The mean surgical procedure time was of 19.0±4.6 minutes; the mean room occupancy time was of 38.0±8.1 minutes and the mean volume of local anesthetic used was of 14.7±2.3 cc. The score for pain, formication and discomfort experienced in the hand was significantly reduced by day 15 (49.1±21.1 vs. 23.5±19.5; P<0.001). Eight patients continued to present with paresthesia on day 15 and only 3 by day 30. Four patients had returned to work by day 15, 10 patients considered that they could have resumed work within an average of 9.9±4.9 days after the procedure. Twenty-five patients estimated that they could resume their daily activities within a mean period of 7±3.9 days. No postoperative complications related to the procedure were observed. CONCLUSION: According to the results of this study, ultrasound-assisted surgical release of carpal tunnel syndrome performed outside the operating theatre seems to be effective and well-tolerated.

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

OBJECTIVE: To assess the feasibility of ultrasound-guided surgery for carpal tunnel syndrome. METHOD: We first studied the ultrasound and anatomic findings in 30 cadaver wrists to determine the best surgical approach and the best plane for releasing the flexor retinaculum. We then used 104 cadaver wrists to assess the feasibility of our technique by performing the surgical procedure then extensively dissecting each wrist and hand. Our evaluation criteria were full release of the transverse carpal ligament and absence of injury to the vessels, nerves, and tendons. RESULTS: The transverse carpal ligament was fully released in all 104 forearms. Full release required a single pass in 61 forearms, two passes in 27 forearms, and three passes in 16 forearms. No injuries to adjacent structures were identified. CONCLUSIONS: Our cadaver study supports the feasibility of percutaneous surgery under ultrasound-guidance for carpal tunnel syndrome.