The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on

Graham, Brent; Peljovich, Allan E.; Afra, Robert; Cho, Mickey S.; Gray, Rob; Stephenson, John; Gurman, Andrew W.; MacDermid, Joy C.; Mlady, Gary; Patel, Atul T.; Rempel, David; Rozental, Tamara D.; Salajegheh, Mohammad; Keith, Michael W.; Jevsevar, David S.; Shea, Kevin G.; Bozic, Kevin J.; Adams, Julie E.; Evans, Jay Mark; Lubahn, John D.; Ray, Wilson Zachary; Spinner, Robert J.; Thomson, Grant; Shaffer, William O.; Cummins, Deborah; Murray, Jayson; Mohiuddin, Mukarram; Mullen, Kyle; Shores, Peter; Woznica, Anne; Linskey, Erica; Martinez, Yasseline; Sevarino, Kaitlyn

doi:10.2106/jbjs.16.00719

Cited by 139 publications

(97 citation statements)

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“…4 The primary goal of CTR is to transect the transverse carpal ligament (TCL) to reduce carpal tunnel pressures. 5 Currently, CTR can be performed by using a mini-open carpal tunnel release (mOCTR), an endoscopic carpal tunnel release (ECTR), or an ultrasoundguided carpal tunnel release (USCTR) approach. Open CTR was first performed by Herbert Galloway, MD, in 1924 using a relatively large (5-to 6-cm) palmar incision.…”

mentioning

confidence: 99%

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

Joseph

Leiby

Beckman³

2019

J of Ultrasound Medicine

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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.

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confidence: 99%

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

Joseph

Leiby

Beckman³

2019

J of Ultrasound Medicine

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“…Depending on the extent of median nerve dysfunction, clinical symptoms and signs may include thenar atrophy, numbness, paresthesia, pain, and weakness in the median nerve distribution . For patients with severe or refractory symptoms, carpal tunnel release (CTR) is recommended to transect the transverse carpal ligament (TCL) and relieve pressure on the median nerve . Annually, over 500,000 CTRs are performed in the United States, primarily using open or endoscopic CTR techniques with superior mid‐ to long‐term outcomes as compared to non‐surgical management …”

mentioning

confidence: 99%

“…[4][5][6] For patients with severe or refractory symptoms, carpal tunnel release (CTR) is recommended to transect the transverse carpal ligament (TCL) and relieve pressure on the median nerve. 7 Annually, over 500,000 CTRs are performed in the United States, primarily using open or endoscopic CTR 8 techniques with superior mid-to long-term outcomes as compared to non-surgical management. 7,9 High-frequency ultrasound (US) can be used to image the carpal tunnel region and assist in the evaluation and treatment of patients with CTS.…”

mentioning

confidence: 99%

“…7 Annually, over 500,000 CTRs are performed in the United States, primarily using open or endoscopic CTR 8 techniques with superior mid-to long-term outcomes as compared to non-surgical management. 7,9 High-frequency ultrasound (US) can be used to image the carpal tunnel region and assist in the evaluation and treatment of patients with CTS. The most commonly used and valid finding in patients with CTS is enlargement of the median nerve in the proximal carpal tunnel region (ie, at or proximal to the scaphoid and pisiform), typically reported as the median nerve cross-sectional area (CSA).…”

mentioning

confidence: 99%

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

Chappell¹,

Beckman²,

Baird

et al. 2019

J of Ultrasound Medicine

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Objective To document changes in the median nerve cross‐sectional area (CSA) in the proximal carpal tunnel region after ultrasound (US)‐guided carpal tunnel release (CTR). Methods Prospective data were collected on 23 consecutive patients (37 wrists) treated with US‐guided CTR by the primary author using the same office‐based microinvasive technique. Ultrasound was used to measure the largest CSA of the median nerve in the proximal carpal tunnel region both preoperatively and postoperatively. The primary outcome measure was the change in the preoperative versus 6‐ to 10‐week postoperative median nerve CSA. Results The mean CSA of the median nerve decreased from 16.08 to 12.75 mm2 at 6 to 10 weeks after US‐guided CTR (P < .001). During the same period, the mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom score decreased from 3.23 to 1.67 (P < .001), and mean BCTQ functional score decreased from 2.49 to 1.47 (P < .001), both exceeding minimal clinically important differences. Although the primary end point was the median nerve CSA at 6 to 10 weeks, statistically significant reductions in the median nerve CSA, as well as BCTQ scores, were also observed as early as 2 to 4 weeks after US‐guided CTR (median nerve CSA, 12.40 mm2; BCTQ symptom score, 2.00; BCTQ functional score, 1.75; all P ≤ .03). Conclusions To our knowledge, this investigation was the largest to date examining changes in the proximal median nerve CSA after US‐guided CTR. Statistically significant reductions in the proximal median nerve CSA were observed within 6 to 10 weeks after ultrasound‐guided CTR. These reductions were similar to those previously reported for open and endoscopic CTR and validate the ability of US‐guided CTR to relieve median nerve compression.

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“…1) [19]. Согласно реко-мендациям Американской ортопедической ассоциа-ции (AAOS) по лечению СЗК оперативное лечение следует проводить пациентам с признаками аксональ-ного повреждения нерва, при отсутствии эффекта консервативной терапии в течение 2-7 нед, а также в случае мотивации пациента на проведение хирурги-ческого вмешательства [20].…”

Section: том 8 Volunclassified

Local administration of corticosteroids in treatment of carpal tunnel syndrome

Киселев¹,

Aleksandrov²,

Короткевич³

2018

Neuromuscular Diseases

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The American Academy of Orthopaedic Surgeons Evidence-Based Clinical Practice Guideline on

Cited by 139 publications

References 0 publications

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

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

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

Local administration of corticosteroids in treatment of carpal tunnel syndrome

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