مقاله انگلیسی رایگان در مورد رها سازی تونل کارپال با هدایت سونوگرافی – الزویر 2022

KEY POINTS 

– This is a new technique for carpal tunnel release thanks to recent improvement in the quality of ultrasound devices.

– The surgical technique is well described and consists in a wrist approach in a retrograde fashion under strict ultrasound control to transect completely the transverse carpal ligament.

– Outcomes of the first 150 patients, tips and tricks are presented and discussed.

– With a dedicated instrument, this is a safe and well-tolerated procedure, efficient, costless.

Preoperative considerations

     Carpal tunnel syndrome (CTS) is one of the most common neuropathies of the upper limb, and affects mainly manual workers. Its prevalence is approximately 5% of the population, and usually is diagnosed in the last active years (50–60 years old), with an increased incidence in women (4:1). Atroshi and colleagues1 showed that the overall prevalence of neuropathy signs in the median nerve distribution is 14.4% (95% CI, 13.0%– 15.8%).

     They also determined that clinically certain CTS prevalence confirmed by electrodiagnostic tests (4.6% for women and 2.8% for men) was close to or somewhat lower than the true prevalence. CTS diagnosis is clinical, with typical symptoms including paresthesia, pain, and weakness in the median motor nerve distribution, often increasing in intensity at night. Ultrasound (US) and electromyography are used as means of additional evaluation and in poor clinically defined cases, if a differential diagnosis is needed. Once a diagnosis is confirmed, either medical or interventional treatment strategies can be used, the choice depending on the severity of the condition and the patient’s decision. Among accepted severity criteria, authors find permanent amyotrophy of the thenar eminence due to its interrupted median nerve innervation, paralysis of thumb opposition, permanent paresthesia, and all forms of hyperalgesia.2 For severe CTS patients (presence of clinical criteria, activity limitations, presentation of poor prognosis factors, and decreased quality of life) and for those who medical treatment failed, interventional options are preferred.

Discussion

     At the end of the follow-up period, significant recovery of grip strength was observed in the studied population. Additionally, pain and acroparesthesias resolved promptly after surgery, normal activities took less than 2 weeks to resume for a large majority of patients, and no serious complications were observed during the first postoperative month. Procedural subjective satisfaction was high in approximately 98% of operated patients, indirectly reflecting good tolerance and functional results of US-guided release of TCL using a new compact scalpel.