Microinvasive Carpal Tunnel Release Using a Retractable Needle‐Mounted Blade

Abstract

We report 166 microinvasive ultrasound‐guided carpal tunnel releases using the MICROi‐Blade (Summit Medical Products, Inc, Sandy, UT), a needle‐based tool for cutting under ultrasound guidance. The 6‐month follow‐up of the first 21 cases, including 5 bilateral releases, showed a progressive reduction in median pain scores, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale scores, and BCTQ Functional Status Scale scores. The median return to work was 7 days. The 3‐month follow‐up of 62 subsequent cases showed similar improvement in the BCTQ scores and return to work. There were no complications. This report supports the effectiveness of the technique.

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

“…There were four case-cohort UPCTR studies [ 17 , 70 , 71 , 72 ]: one compared UPCTR with mini-OCTR [ 17 ]; one investigated UPCTR vs. OCTR [ 72 ]; one evaluated UPCTR using a 22 G hypodermic needle vs. UPCTR plus corticosteroid injection [ 70 ]; and the last case-cohort study compared the use of a UPCTR of an uncoated multifilament stainless steel wire looped thread with no interventions [ 71 ]. Among 16 case series [ 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ], six investigated the effects of different hook knives [ 76 , 79 , 81 , 82 , 87 , 89 ], five evaluated the use of microknives [ 80 , 83 , 85 , 86 , 88 ], two analyzed loop threads [ 77 , 78 ], one assessed a microblade [ 84 ], and one investigated an 18 G needle with a tip bent in the opposite direction to the needle bevel [ 90 ].…”

“…(3) significantly faster wound healing and resumption of daily activities and work [ 21 ], with five studies reporting a return to work as early as the first week post-UPCTR [ 64 , 77 , 78 , 84 ];…”

“…Due to the surgery’s minimally invasive nature and much faster healing, five of the included 24 studies reported simultaneous bilateral UPCTR [ 63 , 83 , 84 , 85 , 88 ], which is not feasible when performing mini-OCTR. Early studies have suggested that UPCTR is an effective, relatively safe treatment option for patients with CTS who have failed to respond to conservative treatments.…”

“…Kamel et al [ 86 ] reported that nearly 39% of patients needed two passes for a complete transection in the presence of a markedly thickened FR. Among the studies using anterograde blades, Fuente et al and Nakamichi et al employed a single passage to divide the FR [ 17 , 66 ], whereas Hebbard et al [ 84 ] used two to three passes to completely transect the FR. The studies using multiple fenestrations with a needle reported requiring 10–15 fenestrations for a complete UPCTR [ 65 ].…”

“…One of the potentially significant benefits of UPCTR is the shortened procedural duration, which may lead to a shorter duration of time in the operation theater or the use of alternate settings, both potentially cost-saving. Only five of the 24 included studies described the average duration of the procedure, which ranged from 5.8 to 16.8 min [ 77 , 79 , 84 , 86 , 88 ]. Eleven studies described the procedural setting, with four performed in the operation theater [ 76 , 80 , 85 , 88 ], six in an ambulatory clinic procedure room [ 63 , 64 , 80 , 81 , 83 , 132 ], and one in an interventional radiology procedure room [ 79 ].…”