Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Outcomes

Ultrasound-guided carpal tunnel release quickly improves hand function and reduces hand discomfort, making the procedure a safe, effective, and less-invasive alternative to traditional open or endoscopic surgery, according to a study recently published by the American Journal of Roentgenology.

Ultrasound guidance allows carpal tunnel release to be performed with smaller incisions and quicker recovery. To determine long-term efficacy of procedure in improving function and discomfort in patients with carpal tunnel syndrome, researchers from Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, retrospectively reviewed 61 ultrasound-guided carpal tunnel release procedures performed in 46 patients with clinically diagnosed carpal tunnel syndrome. All procedures were performed under local anesthetic at an outpatient radiology office using the SX-One MicroKnife (Sonex Health; Eagan, Minnesota).

 

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Patients answered 3 questionnaires – Quick-Disabilities of the Arm, Shoulder, and Hand (QDASH) and 2 parts of the Boston Carpal Tunnel Syndrome Questionnaire: symptom severity (BCTSQ-SS) and functional status (BCTSQ-FS) scales – to assess the affected wrist’s function and discomfort immediately preoperatively, 2 weeks postoperatively, and at least 1 year postoperatively.

Median preoperative scores were 45.4 for QDASH, 3.2 for BCTSQ-SS, and 2.5 for BCTSQ-FS. Median 2-week postoperative scores were 22.5 for QDASH, 1.7 for BCTSQ-SS, and 1.9 for BCTSQ-FS. All decreased from preoperative scores and surpassed reference standards for clinically important difference in scores.

Follow-up questionnaires were obtained for 90% (55/61) of wrists, a median of 1.7 years postoperatively, with further declines 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) had lower BCTSQ (average of BCTSQ-SS and BCTSQ-FS) compared with their preoperative scores.

Although no immediate postoperative complications occurred, 2 patients required surgery for complications experienced 8 to 10 days postoperatively, 1 for infection following injury and 1 for post-traumatic compartment syndrome.

As a result of these complications, modifications have been made to the procedure, including more extensive pre-procedural cleaning that extends to the forearm circumferentially prior to draping and use of a transparent dressing at the distal third of the forearm to act as an additional sterile barrier at the edge of the sterile field. Also, 2 passes of the ligament transection are performed routinely on all patients to potentially decrease the risk of remnant tissue that may contribute to incomplete release.

 

Source

Kamel SI, Freid B, Pomeranz C, Halpern EJ, Nazarian LN. Minimally invasive ultrasound-guided carpal tunnel release improves long-term clinical outcomes in carpal tunnel syndrome. AJR Am J Roentgenol. 2020 Sep 2. doi: 10.2214/AJR.20.24383. Online ahead of print.

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