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. 2020 Nov;15(6):780-784.
doi: 10.1177/1558944719832040. Epub 2019 Mar 12.

Ultrasound Evaluation for Incomplete Carpal Tunnel Release

Jacob E Tulipan  1 , Amir Reza Kachooei  2   3 , Jonathan Shearin  4 , Yvonne Braun  2 , Mark L Wang  4 , Michael Rivlin  4
Affiliations

Ultrasound Evaluation for Incomplete Carpal Tunnel Release

Jacob E Tulipan et al. Hand (N Y). 2020 Nov.

Abstract

Background: Ultrasound can provide evaluation of the anatomy of the carpal tunnel in a convenient, noninvasive office setting. This study is intended to determine the accuracy and diagnostic performance of ultrasound, used by surgeons, for the evaluation of completeness of carpal tunnel release (CTR). Methods: Ten cadaver arms underwent randomized sectioning of 0%, 25%, 50%, 75%, or 100% of the transverse carpal ligament. Following a brief training session, a blinded observer used ultrasound to evaluate the percentage of the transverse carpal ligament release. The release amount was then confirmed with an open exposure of the transverse carpal ligament. Results: Cronbach α and Pearson correlation coefficients were 0.92 and 0.87, demonstrating excellent reliability and validity of the technique. Diagnostic performance including sensitivity, specificity, positive predictive value, and negative predictive value was 100%, 75%, 86%, and 100%, respectively, for the diagnosis of incomplete release of the transverse carpal ligament by a novice sonographer orthopedic surgeon. Conclusions: The ultrasound is a highly accurate tool for the diagnosis of incomplete transverse carpal ligament release and requires a minimal amount of training to use for this purpose. It provides a rapid means of diagnosing incomplete release of the transverse carpal ligament following CTR.

Keywords: carpal tunnel release; incomplete release; persistent carpal tunnel syndrome; ultrasound.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Ultrasound images of posttransection carpal tunnel. (a) Transverse view of the carpal tunnel following transection of the distal transverse carpal ligament. This image is taken through a transected section of the ligament. (b) Transverse view of the carpal tunnel following transection of the full length of the transverse carpal ligament. (c) Longitudinal view of the carpal tunnel following transection of the transverse carpal ligament. Note. 1: median nerve; 2: transverse carpal ligament; 3: flexor tendons; line: area of transected ligament.
See this image and copyright information in PMC

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