title: A cadaveric and preliminary clinical study of ultrasonographically assisted percutaneous carpal tunnel release.
abstract: The aim of this study was to assess the effectiveness and safety profile of a new technique for ultrasonographically assisted percutaneous carpal tunnel release. Experiments were performed on 40 hands in 20 cadavers. We first performed a detailed ultrasonographic examination and correlation study that included surgical dissection of the transverse carpal ligament, the related neurovascular structures and the bony landmarks of the radiocarpal, midcarpal and carpometacarpal joints of the right hand. We then used the measurements we made for percutaneous carpal tunnel release of the transverse carpal ligament using intra-operative ultrasonography for guidance and a hook knife on the left-hand side. The completeness of the release and the potential risks of injury to the flexor tendon and neurovascular bundles were examined. Using real-time intra-operative ultrasonographic monitoring to clearly delineate these targets, we were able to percutaneously release the transverse carpal ligament completely in 18 (90%) of the 20 hands and partially release it in 2 without injuring any neurovascular bundles. We then performed the procedure on 91 consecutive cases of carpal tunnel syndrome and found that the sensory disturbances disappeared in 100% patients 12 mo post-operatively; only 2 hands were graded as unsatisfactory. There were no intra- or post-operative complications. Based on the results from the cadaveric studies and our successful preliminary clinical outcomes, we conclude that this method is tolerable and that its clinical application can be encouraged.
authors.affiliation: Chern Tai-Chang's Orthopedics Clinic, Ping-Tong, Taiwan; Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Tai-Chang
authors.initials: TC
authors.lastname: Chern
authors.affiliation: Department of Orthopedics, Kuo's General Hospital, Tainan, Taiwan; Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, Chang Bing Show Chwan Memorial Hospital, ChangHua, Taiwan.
authors.forename: Lee-Wen
authors.initials: LW
authors.lastname: Huang
authors.affiliation: Department of Orthopedics, Tainan Municipal Hospital, Tainan, Taiwan.
authors.forename: Chung-Jung
authors.initials: CJ
authors.lastname: Shao
authors.affiliation: Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Tong-Tai
authors.initials: TT
authors.lastname: Wu
authors.affiliation: Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Li-Chieh
authors.initials: LC
authors.lastname: Kuo
authors.affiliation: Department of Orthopaedics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: Jming@mail.ncku.edu.tw.
authors.forename: I-Ming
authors.initials: IM
authors.lastname: Jou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
keywords: Carpal tunnel syndrome; Percutaneous release; Ultrasonography