High-resolution sonographic study of the communicating branch of Berrettini: an anatomical feasibility study

Dukan, Ruben; Otayek, Salma; Pierrart, J.; Otayek, Mansour; Silvera, Jonathan; Masméjean, E.

doi:10.1177/1753193421999638

Cited by 4 publications

(2 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The digital nerves most likely to be damaged during TCTR are the TCDN of the median nerve and the BCB between the median and ulnar nerve, which is present in around 80% [ 26 ]. However, because of their clear visualization on high-frequency ultrasound and the hydrodissection technique, iatrogenic injury could be prevented during TCTR in this study.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study

Kim,

Kim

2024

JCM

View full text Add to dashboard Cite

Ultrasound-guided thread carpal tunnel release (TCTR) was proposed as an effective and safe surgical technique with faster recovery and fewer complications. This study was conducted to confirm the long-term outcomes after TCTR and verify its clinical effectiveness in severe carpal tunnel syndrome (CTS) for more insights into TCTR procedure. A total of 168 TCTR procedures were performed in 152 individual patients by two physiatrists during 36-month period. In an assessment of 82 hands, surgical outcomes of 2 years after TCTR could be obtained, and the grade 6 CTS group of 21 hands, classified as extremely severe grade by Bland’s classification, was compared with other severity groups (grade 1–5). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to assess surgical outcomes. No adverse events occurred in all cases including the case of severe CTS and anatomical variants. TCTR showed significant improvement in BCTQ scale within 1–2 weeks, which continued up to 2 years with no recurrence (p < 0.01). Although slower and more progressive than the other severity group, there was also significant improvement relative to the BCTQ scale around 4 weeks after procedure in the grade 6 CTS group (p < 0.05). With the familiarity of ultrasound, ultrasound-guided TCTR is an effective and reliable surgical treatment for CTS in long-term outcomes and in severe CTS.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study

Kim,

Kim

2024

JCM

View full text Add to dashboard Cite

show abstract

“…A cadaveric study suggests a rapid learning curve for achieving complete TCL release after four specimens in less experienced proceduralists 36 ; however, localizing at‐risk structures with ultrasound imaging, such as the median nerve and its recurrent motor branch, the ulnar artery, and the superficial palmar arch, and variants like the Berrettini branch and accessory muscles, may require significant training. In the hands of an experienced physician, the Berrettini branch in cadavers was shown to be accurately injected under high‐resolution ultrasound guidance in 100% of eight cases, 37 but no studies to date have assessed this in less‐experienced proceduralists. Only one study in this review 13 described two cases with at‐risk structures within the safe zones.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided percutaneous carpal tunnel release: A systematic review

Chou

Robinson

Homer

2022

PM&R

View full text Add to dashboard Cite

Objective Carpal tunnel syndrome (CTS) is the most common peripheral entrapment mononeuropathy. The purpose of this systematic review is to evaluate the reported clinical effectiveness and safety of ultrasound‐guided percutaneous carpal tunnel release (USCTR) for the treatment of CTS. Literature Survey PubMed, EMBASE, and ScienceDirect databases were queried from database inception to February 20, 2021, to identify clinical studies on USCTR. Methodology Two reviewers independently completed title, abstract, and full‐text screening, and they extracted data in duplicate for analysis. Procedure techniques, outcome measures, and complications were descriptively analyzed. Synthesis Eighty‐seven studies were eligible for screening. Twenty studies (three randomized controlled trials, three prospective cohort studies, and 14 case series) met inclusion criteria, with a total of 1772 USCTR cases. The overall level of evidence was very low, with seven studies with at least moderate risk of bias. Thirteen studies exceeded the minimal clinically important difference (MCID) for the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ‐SS) and Boston Carpal Tunnel Questionnaire Functional Status Scale (BCTQ‐FS), and six studies exceeded the MCID for the Quick Disabilities of Arm, Shoulder & Hand (QDASH). Five studies reported statistically significant improvement in these functional outcome measures as early as the first week post‐procedure. A major complication occurred in one patient who developed suspected compartment syndrome, and minor complications were reported in 24 patients. Conclusions Based on very low level of evidence, early studies suggest that USCTR may be an effective treatment for CTS, with potential for short post‐procedure recovery times.

show abstract

Clinical-applied anatomy of the carpal tunnel regarding mini-invasive carpal tunnel release

Kaiser,

Schmidle,

Bode

et al. 2024

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Background Carpal tunnel release is a widely performed procedure. Despite a high success rate, iatrogenic neurovascular injuries can occur which lead to a painful and unsatisfying outcome. This study conducted a detailed examination of the anatomy of the carpal tunnel and the proximity of neurovascular structures that are particularly susceptible to injury, especially in the context of minimally invasive carpal tunnel release procedures. Patients and methods The anatomy of the carpal tunnel of 104 wrists of 52 body donors was examined. The precise anatomical location and the presence of variations were recorded for the median nerve, ulnar nerve, ulnar artery and Berrettini branch. The distance between the median nerve, the ulnar artery, the ulnar nerve, and the Berrettini branch was measured in a proximo-distal and radio-ulnar direction in relation to the distal ulnar end of the carpal tunnel. Results The authors identified four main dangerous anatomical situations. (1) A proximal separation of the Long-Finger/Ring-Finger branch of the median nerve together with a narrow safe-zone; (2) an ulnar take-off of the recurrent muscle branch of the median nerve with a close radio-ulnar distance to the distal ulnar end of carpal tunnel; (3) an ulnar arterial arch lying close to the transverse carpal ligament; and (4) a proximal Berrettini branch also lying close to the latter. All situations are illustrated by photographs. Additionally, the authors present a sonographic carpal tunnel assessment protocol in order to reduce the risk of injury of any neurovascular structure in the proximity of the carpal tunnel. Conclusion Certain patients may inherently face an increased risk of neurovascular injuries during minimally invasive carpal tunnel releases due to their anatomical variations. Four potentially risky scenarios were clearly illustrated. Consequently, one may consider conducting a preoperative ultrasound assessment of neurovascular structures at risk, when endoscopic or ultrasound-guided tunnel release are planned. In high-risk patients, open surgery should be preferred. Level of evidence II.

show abstract

High-resolution sonographic study of the communicating branch of Berrettini: an anatomical feasibility study

Cited by 4 publications

References 23 publications

Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study

Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study

Ultrasound‐guided percutaneous carpal tunnel release: A systematic review

Clinical-applied anatomy of the carpal tunnel regarding mini-invasive carpal tunnel release

Contact Info

Product

Resources

About