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American Association for Hand Surgery

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Carpal Tunnel Release with Ultrasound Guidance (CTR-US): Intermediate-Term Results with MRI Correlation
Grace E. Nicholas, M.Sc.1, Joseph C. McGinley, MD, PhD2, Jen Galloway, RN, BSN2 and Jenn Hawley, RT(R), RDMS, RVT2, (1)University of Washington School of Medicine, Seattle, WA, (2)The McGinley Clinic, Casper, WY

Introduction
Several studies have documented the potential advantages of CTR-US, but few have reported clinical results of CTR-US using local anesthesia (WALANT) and objectively documented post-operative changes using MRI. The primary purpose of this study was to report intermediate-term outcomes (3-6 months) following CTR-US using WALANT, including a subset of patients with pre- and post-CTR MRI scans.
Materials & Methods
Patient inclusion criteria: 1) severe or refractory CTS with confirmatory electrodiagnostic testing, 2) treated with CTR-US between 07/08/2019 and 06/08/2021, and 3) pre-operative and at least one post-operative follow-up 2-weeks to 6-months post-CTR. The same clinician performed all procedures in a procedure room using WALANT and the SX-One MicroKnife. Clinical outcomes included: 1) complications, 2) work status at 2 weeks, and 3) QuickDASH and BCTQ scores. Ten wrists were selected for pre- and post-operative MRI scans to evaluate post-CTR morphological changes of the transverse carpal ligament (TCL), median nerve (MN) and carpal tunnel (CT).
Results
A total of 61 wrists/40 patients (ages 22-87 years) met inclusion criteria, including 19 patients (47.5%) treated with simultaneous bilateral releases. At the time of abstract submission, follow-up was available for 53 wrists at 2-weeks, 39 at 1-month, 37 at 3-months, and 20 at 6-months. Patients are being followed for 12-months as part of an IRB approved prospective study. No complications occurred. Work status at 2-weeks was available in 27/29 patients employed at the time of surgery. Ninety-two percent (25/27) had returned to full work duties and 2 to limited duties. One patient on limited duties reported that factors other than CTR recovery had delayed full duty return. Statistically significant reductions in QuickDASH and BCTQ scores were observed at 2-weeks to 6-months (p < 0.001, Figure 1). Post-operative MRIs (Table 1) demonstrated TCL transection in 10/10 wrists as well as reduced MN flattening, increased CT height, reduced median nerve edema (reduced T2 signal intensity) and a palmar shift of the MN consistent with CT decompression.
Conclusion
CTR-US using WALANT in a procedure room setting is safe, effective and results in favorable morphological changes in both the median nerve and carpal tunnel as demonstrated by MRI.


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