American Association for Hand Surgery
Theme: Beyond Innovation

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Ultrasound Guided Carpal Tunnel Release
Thomas TA Apard, MD
Private Hospital Les Franciscaines, Versailles, France

Introduction
Carpal tunnel syndrome is commonly treated with a mini-open or endoscopic procedure. Theorically an ultrasound guided technique permits to assess a precise anatomical diagnosis in the carpal tunnel, avoids nervous compression of a intracanalar device, and cheks the complete section of the carpal ligament. The aim of this study is to evaluate 1. the feasability and 2. the short term outcome of an ultrasound guided carpal tunnel release (US-CTR).
Material and method
In a monocentric prospective study, 850 people (355 men, 495 women, mean age 62 years-old) have been treated under walant (wide awake local anesthesia and no tourniquet). All carpal tunnel syndrome have been diagnosed with an electrophysiological examination.
All the patients were examinated clinically at one month post operative.
Results
The US-CTR have been performed for all patients except one. This patient presented a palmar cyst into the carpal tunnel diagnosed thanks to the ultrasonography, and thus a open technique was performed. The anatomical variations (not considered as a contra-indication of the technique) were: 2 median artery confirmed by a Doppler examination, a double ulnar artery in the Guyon tunnel, and 15 bifid median nerve. A picture of the device through the retinaculum at all the levels was taken as an evidence of the complete release.
In 2 cases, the superficial palmar arch artery was unfortunately sectionned and repaired immediately. There was no nervous injury, one moderate complex regional pain syndrome, and no infection. All the carpal tunnel syndrome disappeared at one month follow-up.
Conclusion
Several studies described the superiority of the outcomes after an US-CTR comparatively to the open techniques. The ultrasound guided technique permitted to diagnose precisely the anatomy, to perform a complete carpal tunnel release with a post-operative picture (legal evidence). Comparative studies of the endoscopic technique vs US-CTR are necessary.


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