A Clinical Study of the Modified Thread Carpal Tunnel Release

Abstract

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.

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

“…Second, all procedures were performed by a single family medicine physician who is board certified in sports medicine and who has extensive experience performing USCTR. Although the inclusion of a single experienced operator might limit the generalizability of the results, USCTR has been successfully performed by individuals from a variety of disciplines and backgrounds . Third, only a single USCTR technique was used in this investigation, as this is the technique currently used by the senior author.…”

“…However, in our opinion, the ambulatory surgery center or operating room setting did not account for our excellent results, as USCTR has been successfully performed in outpatient procedure rooms, and 50% of our cases were performed using only local anesthesia. 16,17,19 In the future, we hope to transition these cases to a less costly procedural room setting.…”

“…Similar to ECTR, one advantage of USCTR is to reduce procedural morbidity and therefore promote a faster recovery However, USCTR provides a larger field of view than ECTR and allows the operator to transect the TCL while visualizing both the ligament and regional neurovascular structures in real time . Currently, more than 640 cases of USCTR have been reported in the peer‐reviewed literature without neurovascular injury and with satisfactory outcomes in greater than 95% of patients . In addition, a recently published prospective randomized trial comparing USCTR to mOCTR reported that USCTR was safe and resulted in statistically and clinically significantly faster recovery than the mini‐open technique …”

“…7,9 Similarly, ECTR was developed to be less invasive than open CTR and transects the TCL through a single 1.0-to 1.5-cm distal forearm incision or both a 1.0-to 1.5-cm distal forearm incision and a 1.0-to 1.5-cm palmar incision, depending on the technique. 10 Nakamichi and Tachibana 11 first published on USCTR in 1997, and there has been increased interest in USCTR during the past 10 years, as evidenced by the number of peer-reviewed publications reporting cadaveric [12][13][14][15] and clinical 8,11,[16][17][18][19][20][21] results using various techniques. Similar to ECTR, one advantage of USCTR is to reduce procedural morbidity and therefore promote a faster recovery 8,21,22 However, USCTR provides a larger field of view than ECTR and allows the operator to transect the TCL while visualizing both the ligament and regional neurovascular structures in real time.…”

Impacts of Re-Vegetation on Surface Soil Moisture over the Chinese Loess Plateau Based on Remote Sensing Datasets

“…Microwave remote sensing technology provides an effective means of detecting soil moisture information in shallow soil layers, and has been widely applied across arid and semi-arid regions [10,13]. Although there are some weaknesses with microwave sensors, such as the coarse temporal resolution and the requirement of complex calibration process and techniques, they offer two major advantages over other methods: (1) long wavelengths (i.e., low frequency) of microwave sensors penetrate deeper into the soil than the sensors using other bands such as visible light, near-infrared, infrared, etc., and are less likely to be affected by cloud cover or daily time-only acquisition conditions; (2) unlike high-frequency-band sensors, which are highly sensitive to vegetation coverage, microwave sensors are less sensitive to vegetation coverage and, therefore, better account for the SMC [14]. Along with the evolvement of the microwave remote sensing technology, there have been a variety of methods developed for the interpretation and utilization of datasets produced by microwave sensors in the past several decades.…”