Clinical Results of Ultrasound‐Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician

Abstract

Objectives The purpose of this study was to determine the safety and efficacy of ultrasound‐guided carpal tunnel release (USCTR) in a consecutive group of patients treated by a single primary care sports medicine physician. Methods The study group consisted of 35 USCTRs performed on 22 consecutive patients for whom clinical outcomes were available before USCTR and at 1 to 2 weeks, 1 month, and 3 months after USCTR. All procedures were performed by the same operator using a single USCTR technique. Outcomes included complications, Quick Disabilities of the Arm, Shoulder, and Hand scores, Boston Carpal Tunnel Questionnaire symptom severity and functional status scores, and a 5‐point global satisfaction score. Results The 22 patients included 13 female and 9 male patients (ages 31–82 years). Eleven patients (22 wrists) had bilateral simultaneous USCTRs; 2 patients (4 wrists) had staged bilateral USCTRs; and 9 patients had unilateral USCTRs. No complications occurred in any patient. Statistically and clinically significant reductions in Quick Disabilities of the Arm, Shoulder, and Hand scores and Boston Carpal Tunnel Questionnaire symptom severity and functional status scores occurred by 1 to 2 weeks after USCTR (mean 1‐ to 2‐week changes, –29.23, –1.74, and –1.18, respectively), and further improvements occurred during the 3‐month follow‐up period (mean 3‐month changes, –51.11, –2.29, and –1.91; P < .0001 for all values versus before USCTR). Mean global satisfaction scores at 1 to 2 weeks and 3 months were 4.63 and 4.66. Conclusions Ultrasound‐guided CTR is a safe and effective procedure that can be performed by an experienced primary care sports medicine physician and typically results in significant improvements within the first 2 weeks after the procedure. Furthermore, bilateral simultaneous USCTRs are feasible and may provide significant advantages for patients who are candidates for bilateral CTRs.

Ultrasound (US) Changes in the Median Nerve Cross‐Sectional Area After Microinvasive US‐Guided Carpal Tunnel Release

“…Comparing these results with previously published studies examining the postoperative proximal median nerve CSA after CTR is challenging because of methodological differences with respect to patient populations, US equipment, measurement techniques, operator experience, and follow‐up periods. Nonetheless, the quantitative reductions in the CSA observed in this investigation are similar to those reported previously for open CTR, endoscopic CTR, and the single published case report of US‐guided CTR …”

“…Nonetheless, the quantitative reductions in the CSA observed in this investigation are similar to those reported previously for open CTR, endoscopic CTR, and the single published case report of US-guided CTR. 3,[14][15][16][17][18][19][20][21][22]29 Two observations regarding our median nerve CSA warrant further discussion. First, significant reductions in the nerve CSA were observed as early as 2 to 4 weeks after US-guided CTR ( Table 2 and For simultaneous bilateral patients, the mean CSA change between the two wrists was used.…”

“…Although most CTRs in the United States have been traditionally performed by using open or endoscopic approaches, advances in US technology have promoted the development of US‐guided techniques to transect the TCL (ie, US‐guided CTR). To date, more than 640 cases of US‐guided CTR have been reported in the peer‐reviewed literature, with a clinical success rate of greater than 95%, no major complications, and in some studies, superior early outcomes compared to traditional open CTR . However, only 3 previous publications evaluated the median nerve after US‐guided CTR.…”

“…To date, more than 640 cases of US-guided CTR have been reported in the peer-reviewed literature, with a clinical success rate of greater than 95%, no major complications, and in some studies, superior early outcomes compared to traditional open CTR. [22][23][24][25][26][27][28][29][30] However, only 3 previous publications evaluated the median nerve after US-guided CTR. McShane et al 31 reported a statistically significant reduction in the proximal median nerve CSA among 11 patients evaluated at a minimum of 6 months (mean, approx.…”

Current and future applications of ultrasound imaging in peripheral nerve disorders

“…US guided minimally invasive carpal tunnel release is increasingly being used, in both surgical and primary care settings, for rapid, carpal tunnel decompression with good clinical outcomes[ 262 - 265 ]. Specifically, these techniques allow concurrent bilateral decompressions, earlier functional recovery and less post-operative morbidity with equivalent neurological outcomes to mini-open carpal tunnel release[ 262 - 264 ]. In addition pulsed, low-frequency US has been used for non-invasive neuromodulation in compressive neuropathy and radiculopathy reducing pain and improving quality of life in affected individuals[ 266 ].…”