Early Postoperative Recovery after Modified Ultra-Minimally Invasive Sonography-Guided Thread Carpal Tunnel Release

Abstract

Thread carpal tunnel release (TCTR) has been reported to be safe and effective for the treatment of carpal tunnel syndrome. The aim of this study is to evaluate the modified TCTR for safety, efficacy, and postoperative recovery. Seventy-six extremities in 67 patients undergoing TCTR were analyzed pre- and postoperatively using clinical parameters and patient-reported outcome measures. Twenty-nine men and 38 women with a mean age of 59.9 ± 18.9 years underwent TCTR. The mean postoperative time to resume activities of daily living was 5.5 ± 5.5 days, analgesia was completed after 3.7 ± 4.6 days, and return to work was achieved after a mean of 32.6 ± 15.6 days for blue-collar workers and 4.6 ± 4.3 days for white-collar workers. The Boston Carpal Tunnel Questionnaire (BCTQ) and Disability of Arm, Shoulder, and Hand (DASH) scores were comparable with previous studies. Overall, two persistent compressions and one recurrence required open reoperation (3.9%). All three had been operated in the initial phase, and none required reoperation after an additional safety step was introduced. No other complications occurred. TCTR surgery appears to be a safe and reliable technique with almost no wound and scarring and a potentially faster recovery time than open techniques. Although our technical modifications may reduce the risk of incomplete release, TCTR requires both ultrasound and surgical skills and has a considerable learning curve.

Keywords: carpal tunnel syndrome; minimally invasive; percutaneous; sonography; thread release; ultra-minimally invasive; ultrasound.

Figure 1

Sagittal distal palmar sonographic view. Arrow = distal needle insertion site; SC = subcutaneous tissue; TCL = transverse carpal ligament; DB = duck’s beak; SPA = superficial palmar arterial arch.

Figure 2

Sagittal proximal palmar view. HD = hydrodissected area; FDT = flexor digitorum profundus and superficialis tendons; TCL = transverse carpal ligament; SupA = superficial palmar aponeurosis.

Figure 3

Surgical site after the second pass of the 18 G cannula under the superficial palmar aponeurosis and looping of the thread, including anatomical landmarks and the direction of passage of the thread.

Figure 4

Development of operation duration (minutes) over time.

Figure 5

Development of the overall Boston Carpal Tunnel Questionnaire (BCTQ) over time. (* and ° present outliers).

Figure 6

Development the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire over time. (° present outliers).