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A Comparison of Changes in Ultrasound Cross-sectional Area of the Median Nerve Between Three Commonly Utilized Carpal Tunnel Release Techniques
Cory J Demino, MD1, Landon Cluts, BS1 and John R Fowler, MD2, (1)University of Pittsburgh School of Medicine, Pittsburgh, PA, (2)UPMC, Pittsburgh, PA

Introduction: Ultrasound has been well-established as a diagnostic modality for carpal tunnel syndrome (CTS), but its prognostic utility has not been deeply investigated. In 2019, Smith et al. showed that patients undergoing endoscopic carpal tunnel release (ECTR) had a decrease in median nerve cross-sectional area (CSA) at six weeks post-operatively while patients undergoing open CTR showed an increase in CSA at the same time period. The goal of this study was to compare the change in median nerve CSA and Boston Carpal Tunnel Questionnaire (BCTQ) score at the six-week follow up time between endoscopic, limited incision, and open CTR.

Materials & Methods: Patients with CTS were evaluated with ultrasound and the BCTQ before and six weeks post-surgery. Patients were eligible for inclusion if they underwent ECTR, limited incision carpal tunnel release (LICTR), or open carpal tunnel release (OCTR). Two surgeons performed all surgeries. Choice of surgery type was at the discretion of the surgeon. Changes in median nerve CSA and BCTQ scores and their associated surgical techniques were analyzed.

Results: A total of 63 hands in 57 patients were included in this study: 41 ECTR, 12 LICTR, and 10 OCTR. The average ∆BCTQ scores were 1.36, 1.32, and 1.47 for ECTR, LICTR, and OCTR respectively. The average ∆CSA were 1.80, -0.50, and -0.70 mm2 for ECTR, LICTR, and OCTR respectively.

Conclusions: Median nerve CSA increased in both LICTR and OCTR but decreased in ECTR. The significance of this finding is unclear but may explain early recovery and return to work in ECTR.

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