Original articleUltrasound-guided percutaneous surgery for carpal tunnel syndrome: A cadaver study
Introduction
A medico-economic evaluation of open and endoscopic surgery for idiopathic carpal tunnel syndrome (CTS) was performed in December 2002 by the French Healthcare Product Safety Agency (ANAES) in answer to a request from the public healthcare insurance fund (CNAMTS) [1]. The comparisons of efficacy, utility, costs, and benefits found no significant differences in efficacy or safety between open and endoscopic surgery. The experts who conducted the study suggested performing a prospective randomized trial to look for differences in complication rates between the two techniques; to assess additional efficacy criteria, such as resumption of former activities and quality-of-life indices reflecting patient satisfaction; and to measure the costs associated with each technique [1]. To date, these points have not been evaluated.
We have been using ultrasonography for several years for the diagnosis of CTS. We believe that percutaneous ultrasonography-guided surgery deserves consideration for the treatment of CTS. Here, we report the results of a cadaver study that constitutes the first step in the development of percutaneous ultrasonography-guided CTS surgery.
Section snippets
Surgery for carpal tunnel syndrome in France
CTS surgery is commonly performed in France. In 1999, about 79,000 surgical procedures for CTS were recorded in the nationwide hospital database, which collects data from both public and private hospitals [1]. This database does not distinguish between open and endoscopic procedures performed on an outpatient basis, that is, with a hospital stay shorter than 24 hours. Surgery for CTS is usually performed as an outpatient procedure in France. The large number of surgical procedures for CTS
Methods: cadaver study
The cadaver study reported here was performed by a rheumatologist with experience in interventional rheumatology and, more specifically, in interventional ultrasonography. This rheumatologist had no experience with endoscopy. The ultrasound machine used for the study was a 2005 Esaote Technos device (Esaote, Genoa, Italy) equipped with a 15 mHz probe.
We first used 30 cadaver wrists to develop the technique. The ultrasound features of the carpal tunnel and adjacent structures were assessed, with
Results
Of the 107 wrists, 104 were studied successfully. Deterioration of the remaining three wrists with reduced tissue echogenicity precluded ligament release via an ultrasound-guided procedure. In the 104 wrists, complete ligament release was consistently achieved, with no injuries to vessels, nerves, or tendons. One pass was required for 61 wrists, two for 27 wrists, and three for 16 wrists. The need for more than one pass was chiefly related to the thickness of the ligament and size of the wrist.
Discussion
Ultrasonography of the carpal tunnel has been used for several years, chiefly to diagnose CTS and to identify causes of the condition. Many studies have compared ultrasonography to electrophysiological testing for the diagnosis of CTS. Ultrasonography is also useful for detecting causes of CTS as part of the pretreatment evaluation. Thus, ultrasonography readily identifies flexor tenosynovitis or a foreign body within the carpal tunnel, either of which may cause CTS. A study of percutaneous
Conflict of interest statement
The authors declare no conflict of interest.
References (5)
- et al.
Endoscopic release of the carpal tunnel: a randomized prospective multicenter study
J Hand Surg Am
(1992) Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome
Arthroscopy
(1989)
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