UPMC Video Rounds - Ultrasound-Guided Carpal Tunnel Release

December 24, 2019

 

Daniel Lueders, MD, assistant professor, Department of Physical Medicine and Rehabilitation:

So we're introducing a, a new novel procedure using ultrasound guidance to perform a carpal tunnel release. The device that we'll be using is the Sonex SX-One MicroKnife. And with that device we'll make a small incision on the forearm in the antebrachial fascia proximal to the wrist crease and introduce the device into the carpal tunnel to perform an ultrasound guided release of the transverse carpal ligament and then remove the device with only a small three to five millimeter skin incision.

Ultrasound is used to identify the median nerve in the carpal tunnel and then identify the branches the sensory and motor branches, of the nerve to ensure their safety and their location as well as to identify the vasculature in the proximity of the nerve and the transverse carpal ligament. What this procedure affords is a more proximal incision from the palmar fascia and palmar skin, and so it's a distal forearm incision proximal to the wrist crease and so patients are allowed to bear weight, to use their hand, almost immediately after the procedure which can be an improvement upon open procedures which require closure of stitches or sutures over the skin of the hand. The research with this procedure relates to its effectiveness and patient satisfaction relative to the more standard of care or standard practice with the open release, so measuring patient's outcomes and satisfactions in the days after the procedure to really highlight the success of the immediate use of the hands, but also studying it several months to several years out.

Because this is a relatively new and novel procedure, we want to ensure that we're performing effective procedure that has durable benefits months to years out as the more standard typical open procedure does. I see procedures like this with less invasive tools becoming the future of medicine as we gain better ability to visualize the anatomy and our tool and create smaller incisions with less debility and less downtime after a procedure. And so I think this procedure really pushes the envelope and pushes the technology on a procedure that is performed almost 500,000 times per year across the country. And so a procedure like this will permit earlier return to work, earlier return to recreational activity and improve patient outcomes.

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