Elsevier

Joint Bone Spine

Volume 78, Issue 5, October 2011, Pages 516-518
Joint Bone Spine

Original article
Ultrasound-guided percutaneous surgery for carpal tunnel syndrome: A cadaver study

https://doi.org/10.1016/j.jbspin.2010.12.006Get rights and content

Abstract

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.

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)

There are more references available in the full text version of this article.

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