Ultrasound-Guided Incisionless Carpal Tunnel Release Using a Hook Knife: A Cadaveric Study.

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy of the median nerve. In comparison to open surgical and endoscopic carpal tunnel release, a new ultrasound-guided hook knife carpal tunnel release (CTR) procedure was reported to have superior results in terms of reduced morbidity and early return to work.

OBJECTIVE

To evaluate the reproducibility of the hook knife CTR procedure when performed by musculoskeletal ultrasound trained physicians without prior experience in this technique.

DESIGN

Cadaveric study.

SETTING

Tertiary-level academic institute.

PARTICIPANTS

Sixteen lightly embalmed forearm and hand specimens.

METHODS

The ultrasound-guided CTR was done using a 1-mm proximal wrist puncture, creation of a tunnel, followed by the retrograde percutaneous release of the transverse carpal ligament (TCL) using a 3-mm hook knife.

MAIN OUTCOME MEASUREMENTS

Assessment of the completeness of TCL release, the integrity of the surrounding neurovascular structures, and the technical and subjective procedural difficulty encountered during the procedure.

RESULTS

In 14 of 16 specimens, complete release of the TCL was achieved. In two specimens with an incomplete release, the TCL resection was 52% and 55%, respectively. The integrity of the surrounding neurovascular structures and superficial anatomy volar to the dissection path was maintained in all specimens. The mean level of procedural difficulty was 2.6 (range 2-4) on a Likert 5-point rating scale.

CONCLUSIONS

In cadavers, the ultrasound-guided hook knife CTR procedure was found to be reproducible when performed by ultrasound-trained physicians with no experience in this technique. Further in vivo investigations are required.