Percutaneous Ultrasound-Guided Techniques for Carpal Tunnel Release: A Descriptive Review

Abstract

Carpal tunnel syndrome (CTS) is a prevalent compressive peripheral neuropathy that often requires surgical treatment due to symptom severity or medical treatment failure. The recent popularity of ultrasound-guided (US) percutaneous surgery to treat these neuropathies has made this minimally invasive technique a good option over traditional open techniques. This review sought to identify, classify, and describe the minimally invasive percutaneous US-guided techniques reported in the literature for carpal tunnel release (CTR). Thirty reports were identified describing 22 different techniques. No systematic reviews addressing this topic were found. Of the 30 studies reviewed, only five (describing four techniques) were randomized controlled trials (RCT), three were non-randomized controlled trials, and 22 were uncontrolled studies. The technical characteristics most frequently described by the different authors were: 13 MHz US-probe, incisions 2 to 15 mm, section direction retrograde, incision orientation longitudinal, entry point carpal, with a single incision technique. As further characteristics, cutting instruments varied widely, few studies reported on the use of tourniquet and nearly all of them used local anesthesia. Our descriptive review shows that minimally invasive percutaneous US-guided surgery for CTR offers multiple technical possibilities. As only four of these techniques have been the focus of RTCs, more work is needed to assess the efficacy of this approach in improving the pain and hand functionality problems experienced by patients with CTS.

Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity

“…Several different techniques have been described. 68 A single-use disposable device has recently become available that uses expandable protective balloons to allow for a consistent carpal tunnel transverse safe zone while a retractable microknife cuts the TCL. 69 Leiby et al 70 reported on the 1-year follow-up for patients who underwent ultrasound-guided CTR and found statistically and clinically significant improvements in Boston Carpal Tunnel Questionnaire symptom severity and functional status scores as well as Quick Disabilities of the Arm, Shoulder, and Hand scores, with high patient satisfaction and no documented complications or recurrent symptoms.…”