A Randomized Clinical Trialith an incidence of 1 to 3 cases and a prevalence of 50 cases per 1000 person-years, carpal tunnel syndrome is the most diagnosed entrapment neuropathy. 1,2 A course of nonsurgical treatment, is an option in carpal tunnel syndrome. When nonsurgical treatment fails to resolve the symptoms, surgery is considered a valid option. Carpal tunnel release can be considered as a first effective option if there is denervation or the patient elects surgery. 1,3-5 When comparing carpal tunnel release techniques with different incision lengths, smaller incisions show a faster return to work, better cosmetic results, 6,7 and lower pain rates. 4,[8][9][10][11][12] Incision sizes Jose Manuel Rojo-Manaute, MD, PhD, Alberto Capa-Grasa, MD, PhD, Francisco Chana-Rodríguez, MD, PhD, Ruben Perez-Mañanes, MD, PhD, Guillermo Rodriguez-Maruri, MD, Pablo Sanz-Ruiz, MD, PhD, Jorge Muñoz-Ledesma, MD, Mikel Aburto-Bernardo, MD, Luis Esparragoza-Cabrera, MD, Miguel del Cerro-Gutiérrez, MD, PhD, Javier Vaquero-Martín, MD, PhD Received July 2, 2015, ORIGINAL RESEARCHObjectives-The purpose of this study was to compare the outcomes of 1-mm ultraminimally invasive ultrasound-guided carpal tunnel release and 2-cm blind mini-open carpal tunnel release.Methods-We conducted a single-center individual parallel-group controlled-superiority randomized control trial in an ambulatory office-based setting at a third-level referral hospital. Eligible participants had clinical signs of primary carpal tunnel syndrome and positive electrodiagnostic test results and were followed for 12 months. Independent outcome assessors were blinded. Patients were randomized by concealed allocation (1:1) by an independent blocked computer-generated list. The postoperative score on the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was the primary variable. Grip strength and time for discontinuation of oral analgesics, complete wrist flexion-extension, relief of paresthesia, and return to normal daily activities (including work) were assessed. Conclusions-Ultra-minimally invasive carpal tunnel release provides earlier functional return and less postoperative morbidity with the same neurologic recovery as mini-open carpal tunnel release for patients with symptomatic primary carpal tunnel syndrome.

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BackgroundIsolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure.The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra–minimally invasive gastrocnemius recession.MethodsWe performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion before and after the procedure, clinical outcomes with VAS and AOFAS scores, and potential complications, including neurovascular injuries.ResultsWe achieved complete release of the gastrocnemius tendon in all cases in the cadaveric study, with no damage to the sural nerve or vessels and minimal damage to the underlying muscle fibers. Ankle dorsiflexion increased for every patient in the study (mean, 14°; standard deviation, 3°) and was maintained throughout follow-up. The mean preoperative VAS score was 7 (6–9), which improved to 0 (0–1). The AOFAS Ankle-Hindfoot Score improved from a mean of 30 (20–40) to 93 (85–100) at 6 months. No major complications were observed. All patients returned to their previous sports after 6 months.ConclusionsAfter cadaveric and clinical study, we considered the technique to be safe and effective to perform ultrasound-guided ultra–minimally invasive gastrocnemius recession using a 1-mm incision in vivo. This novel technique represents an alternative to open techniques, with encouraging results and with the advantages of reducing pain, obviating lower limb ischemia, deeper anaesthesia, thus decreasing complications and contraindications and accelerating recovery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1265-7) contains supplementary material, which is available to authorized users.

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This study describes a new ultrasound-guided surgical technique for aponeurotomy and interphalangeal joint capsular release in patients with Dupuytren’s disease and analyses the clinical outcomes. We carried out a retrospective review of 70 digits in 35 patients who underwent ultrasound-guided aponeurotomy and interphalangeal joint capsular release, with a minimum follow-up of 2 years. The primary outcome was the correction of the deformity and the QuickDASH questionnaire score after surgery and at 1 and 2 years. The secondary outcome was the presence of residual contracture immediately after surgery. The mean QuickDASH score fell from 28 before surgery to 14 after surgery. A significant decrease of −63° was observed for the global contracture, −35° the metacarpophalangeal joint contracture and −28° for the proximal interphalangeal joint contracture. Ultrasound-guided aponeurotomy and interphalangeal joint capsular and palmar plate releases are highly accurate and safe. Level of evidence: IV