Abstract

KEY POINTS

– The surgical carpal tunnel procedure under sonography prevent intraoperative neurovascular injury.

– The sonography can also be used for carpal tunnel syndrome diagnosis and the surgical release.

– As a low-irradiation imaging technic, sonography can also be used for the trigger finger surgical procedure without skin incision.

– The percutaneous carpal tunnel procedure can be done without tourniquet and prevent from thromboembolism complication.

Introduction

     Carpal tunnel syndrome (CTS) is the most frequent compressive neuropathy.1 In Belgium, in 2018, there were 31,938 carpal tunnel releases (CTRs) performed with an annual direct reimbursement cost of 6,142,052 V. Most patients (64.4%) were women, and the median and average ages were 58 and 59.3 years, respectively. The vast majority of the operations (97.1%) were performed in an ambulatory day clinic.2

     The classical surgical alternatives are Open and Endoscopic Carpal Tunnel Releases (OCTR and ECTR). In 2016, the American Academy of Orthopaedic Surgeons (AAOS) concluded that ECTR offers some benefits as compared to OCTR.3 Sonography is now used more and more in CTS, for the diagnosis,4 but also, by some physicians, during surgery. Already in 1997, Nakamichi suggested using sonography during CTR.4 More recently, sonography has been proposed to guide the release of the transverse carpal ligament (TCL) using various endoscopic devices, or needles permitting sonography-guided percutaneous carpal tunnel release (PCTR). Several cadaveric studies have assessed the efficacy of PCTR.5,6 Lecoq and colleagues reported in their series of 104 specimens, a total release of TCL in all cases. For 61 specimens, the complete release was obtained at first cutting movement.6 In clinics, PCTR has been reported to be safe and could allow quicker return to daily activities and work.7

Results

     A total of 141 patients (143 hands) were operated for CTS at Erasme University Hospital in 2019. After exclusion criteria, 116 patients were included in the analysis: 35 men (mean age, 60 years) and 81 women (mean age, 54 years), 75 on the right side and 41 on the left side. Seventy-eight patients were operated by PCTR, 35 by OCTR, and 3 by ECTR. PCTR was performed by one single surgeon experimented in sonography (FM), OCTR and ECTR by multiple hand surgeons. Among the 116 operated patients, 29 were operated under regional anesthesia, 4 under general anesthesia, and 83 (including all PCTRs) under local anesthesia (Table 2). The average operative durations were similar for OCTR (15  ۸ min) and PCTR (15  ۶ min), inferior to those of ECTR (29  ۱۰ min) (Fig. 1). The same difference was found for the total duration of occupation of the operating room (OCTR, 43  ۱۷ min; PCTR, 47  ۱۰ min; ECTR, 64  ۳۴ min).