American Association for Hand Surgery
Theme: Beyond Innovation

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Ultrasound Guided Carpal Tunnel Release: Initial Results
Sam Chen, MD1; Michael Kenji Yamazaki, MD1; Edward J Weldon, BS2
1Straub Medical Center, Honolulu, HI, 2Massachusetts Institute of Technology, Cambridge, MA

Introduction
Carpal tunnel release provides excellent outcomes and is well studied in the peer-reviewed literature. The United States has prioritized high quality healthcare performed at a lower cost. Ultrasound guided carpal tunnel release (USCTR) is currently being studied as a safe and effective procedure that may reduce the cost of care while promoting faster recovery. This study presents our early clinical results.

Materials & Methods
Between September, 2017 and July, 2018 USCTR was performed on 61 patients (65 wrists) ages 37-92 years with a first time diagnosis of carpal tunnel syndrome. All procedures were performed by a fellowship trained orthopedic hand surgeon (58 wrists) and a sonography-certified physiatrist (7 wrists) in a single multi-disciplinary center using a high frequency linear ultrasound transducer and the MicroKnife, an ultrasound specific device by Sonex Health. All 65 procedures were performed in an outpatient surgical center. Sedation was used in 39 procedures. A transition was made to only local anesthesia in 26 procedures. Outcome metrics included the following: 1) requirement for conversion to conventional procedure, 2) complications, 3) the Boston Carpal Tunnel Questionnaire (BCTQ) and 4) the QuickDASH Questionnaire. Two-month follow-up data was available for 52 patients at time of abstract submission. All patients are being followed prospectively and data will be updated at the time of presentation.

Results
61 patients underwent successful USCTR. Four patients with bilateral symptoms had a contralateral release for a total of 65 USCTR procedures. No conversions were necessary, all incisions were well healed at 1 week follow up, and patients were allowed to return to functional activities and employment as tolerated. At two-month follow-up (52 patients) there were no complications and mean patient reported outcomes were QuickDASH = 13, BCTQ-SS = 1.3, and BCTQ-FS = 1.4.

Conclusion
Our early clinical results demonstrate indicate USCTR can be performed safely and effectively. As our clinical experience has grown, more procedures were performed using only local anesthesia resulting in reduced operative overhead and possible cost savings. User and patient satisfaction have been high. Our observations suggest that patients may recover faster and return to work sooner following USCTR compared to mini-open carpal tunnel release. However, further study is warranted to investigate these early observations.


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