A Cadaveric Study for the Improvement of Thread Carpal Tunnel Release

Guo, Danqing; Guo, Danzhu; Guo, Joseph; Malone, Daniel G.; Wei, Nathan; McCool, Logan

doi:10.1016/j.jhsa.2016.07.098

Cited by 32 publications

(42 citation statements)

References 20 publications

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“…In a recent study on 11 unembalmed cadaveric wrists, the modified TCTR procedure was verified and the needle control accuracy was measured to be 0.15 to 0.2 mm, which is precise enough to protect the superficial palmar aponeurosis (SupPA), Berrettini branch, and common digital nerves. 14 …”

Section: Introductionmentioning

confidence: 99%

A Clinical Study of the Modified Thread Carpal Tunnel Release

Guo

Guo³

et al. 2016

Hand (New York, N,Y.)

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109

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Background: Previous studies have indicated that the thread carpal tunnel release (TCTR) is a safe and effective technique. Through a study on 11 cadaveric wrists, the TCTR procedure was modified and the needle control accuracy was improved to 0.15 to 0.2 mm, which is precise enough to preserve superficial palmar aponeurosis (SupPA), Berrettini branch, and common digital nerves. The aim of the present study was to verify the modified TCTR clinically. Methods: The modified TCTR was performed on 159 hands of 116 patients. The Boston Carpal Tunnel Syndrome Questionnaire was used for assessing the outcomes. Statistical analyses were used to compare the outcomes with the available data from the literature for the open and endoscopic techniques. Results: TCTR led to significant improvement in the short-term results, and the outcomes were better in long-term results compared with the open or endoscopic release. The SupPA, Berrettini branch, and common digital nerves were protected. There was no neurovascular complication for any case. Significant relief of symptoms was observed 3 to 5 hours post procedure. Most patients used their hands on the day of the procedure for simple daily activity. Patients reported their sleep quality was improved on the surgical day. Most patients with office jobs were able to return to work on postoperative day 1, and those with repetitive jobs returned to work in about 2 weeks. The statistical evidence proves that the modified TCTR procedure results in improved clinical outcomes as compared with open carpal tunnel release (CTR) and endoscopic CTR. Conclusions: The TCTR procedure has been shown to be a safe and effective technique for CTR. The modified TCTR procedure minimizes postoperative complications, such as pillar pain, scar tenderness, or functional weakness, by avoiding unnecessary injuries to the surrounding structures around the transverse carpal ligament during the procedure.

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Section: Introductionmentioning

confidence: 99%

A Clinical Study of the Modified Thread Carpal Tunnel Release

Guo

Guo³

et al. 2016

Hand (New York, N,Y.)

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109

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“…The cutting wire has been previously studied for other USG surgical procedures. Prior cadaveric and clinical investigations have demonstrated that USG cutting wire releases for carpal tunnel syndrome and trigger fingers are safe and effective 15,16,21–23 . We recently completed a study demonstrating the feasibility of an USG adductor longus tendon release using a cutting wire 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Initially, US was used for simple procedures, such as USG joint, bursa, and tendon sheath injections. More recently, advanced needle based procedures (eg, needle tenotomy) and USG surgical procedures (compartment fasciotomies, ultrasonic tendon debridement, carpal tunnel releases, adductor longus releases, long head of the biceps tendon releases) have been introduced into orthopedic and sports medicine settings 13–19 . USG procedures may offer the benefit of lower risk, less pain, quicker recovery, and lower cost when compared to open surgical procedures 20 .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study

Boettcher

Hollman

Stuart

et al. 2020

PM&R

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Background Distal iliotibial band friction syndrome (ITBFS) is a common cause of knee pain in endurance athletes. Nonsurgical treatment is usually successful, but surgery is occasionally required for recalcitrant cases. No published studies to date have evaluated the feasibility of an ultrasound‐guided (USG) partial iliotibial band (ITB) release. Objective To determine the feasibility of an USG partial ITB release using a cutting wire. A secondary aim was to assess whether adjacent structures were damaged. We hypothesized that the posterior distal ITB could be partially transected with a cutting wire under USG with no injury to adjacent structures. Design Cadaveric study. Setting Quaternary‐care academic institute. Participants Ten cadaveric knees ranging from 76‐89 years old with a mean body mass index of 21.9 kg/m2. Interventions One physician sonographer performed USG releases of the posterior ITBs at the level of the lateral femoral epicondyle with a cutting wire. Dissection was carried out by an independent second physician to assess for primary and secondary outcomes. Main Outcome Measures (1) Release of the posterior border of the ITB; (2) width of the release; (3) evaluation for any injury to adjacent structures; (4) technical difficulty of the procedure (0 = no difficulty, 10 = most difficult procedure possible); (5) duration of time it took to complete the procedure. Results All 10 knees had the posterior border of the ITB transected. Mean release length was 16 mm (range 15‐17), which was within 1 mm of the target release length of 15 mm. No adjacent structures were damaged. Conclusion A USG release of the posterior ITB utilizing a cutting wire is feasible and safe in a cadaveric model. Translational research is warranted to determine how these results apply to the clinical setting.

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“…In the accompanying figures, the indication of the distal part of the duck's beak shows a short, tapered end, which is unclear in the accompanying US image. Guo et al subsequently defined their concept of the duck's beak with an elongated distal segment superficial to the fat pad enclosing the distal transverse carpal ligament, describing this appearance as the blending of the ligament with the palmar aponeurosis. The subsequent diagram of the position of their cutting thread excluded this elongated distal segment, which represented the palmar aponeurosis alone.…”

Section: Discussionmentioning

confidence: 99%

“…To be described as microinvasive, a procedure needs to be performed without incisions: that is, with 14‐gauge (2.1‐mm) or smaller needle‐sized instruments that will not leave a notable scar. Microinvasive approaches to cutting the transverse carpal ligament have been described, including an abrading saw with entry and exit holes and a cutting thread or wire, threaded through a needle from the palm to a wrist exit hole and then back again to encircle and cut the transverse carpal ligament while preserving the palmar aponeurosis . Simple repeated needle fenestration of the transverse carpal ligament has also been described …”

mentioning

confidence: 99%

Ultrasound‐Guided Microinvasive Carpal Tunnel Release Using a Novel Retractable Needle‐Mounted Blade: A Cadaveric Study

Hebbard¹,

Hebbard

Tomka

et al. 2018

J of Ultrasound Medicine

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Ultrasound (US)-guided microinvasive procedures are defined as those performed via needles without notable scarring. Ten cadaver hands underwent US-guided microinvasive carpal tunnel release using a novel needle-based tool, the micro i-Blade (Summit Medical Products, Inc, Sandy, UT). A US-imaged landmark, the inflexion point of the ligaments distal to the hook of the hamate, was used to position the distal extent of the cut. The transverse carpal ligament was successfully released in all hands without damage to nerves or arteries. In 3 specimens, the fascia between the thenar and hypothenar muscles was partly preserved, whereas the palmar aponeurosis was partly cut in 1 specimen. The micro i-Blade with the cutting knife retracted was also useful as a probe palpated through the palm of the cadaver hand, to test the release of the transverse carpal ligament and to guide the procedure.

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A Cadaveric Study for the Improvement of Thread Carpal Tunnel Release

Abstract: The modified TCTR has the potential to offer a clinically safe and effective minimally invasive procedure for complete carpal tunnel release.

Cited by 32 publications

References 20 publications

A Clinical Study of the Modified Thread Carpal Tunnel Release

A Clinical Study of the Modified Thread Carpal Tunnel Release

Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study

Ultrasound‐Guided Microinvasive Carpal Tunnel Release Using a Novel Retractable Needle‐Mounted Blade: A Cadaveric Study

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