In-office ultrasound-guided carpal tunnel release mitigates need for conversions
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In-office ultrasound-guided carpal tunnel release is associated with no need for added sedation or analgesia, or conversion to mini-open carpal tunnel release, a speaker said at the American Society for Surgery of the Hand Annual Meeting.
Surgeons treated 106 hands in 76 patients with a mean age of 65 years; 83% of hands had one or more comorbidities. In addition, they treated 55 hands in 28 patients as part of simultaneous bilateral procedures performed during the study period of March 2019 to March 2020.
“All patients tolerated the procedure in the office,” Russell Bergum, DO, of the Mayo Clinic Health System in Albert Lea, Minnesota, said. He noted one patient developed complex regional pain syndrome-like pain at 2 weeks postoperatively, which resolved within about 4 weeks.
“There were no other postoperative complications and no recurrences or reoperations within the 1-year follow-up period,” he said.
Patients completed Boston Carpal Tunnel Syndrome Questionnaires (BCTQ) and quick DASH (qDASH) at 2 weeks, 1 month, 3 months and 1 year postoperatively. Clinical results based on recovery curves for the BCTQ and qDASH showed these scores improved significantly “as early as 2 weeks, which persists at 1 year,” Bergum said.
Furthermore, based on the recovery results, both sets of scores showed statistically significant improvement at all postoperative timepoints compared with preoperative levels, according to Bergum.
“Carpal tunnel release using ultrasound guidance was well tolerated, safe and effective and resulted in rapid clinical improvements that were durable at 1-year follow-up, including patients with moderately severe or severe disease, or patients treated with simultaneous bilateral procedures,” he said.
None of the patients were prescribed splinting or physical therapy postoperatively.
Perspective
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Carpal tunnel release is among the most common and most successful orthopedic and hand surgical procedures. It has seen a number of innovations over time, including the development of endoscopic and mini-open techniques. More recently, carpal tunnel release (CTR) surgeries are being performed more frequently under just local anesthesia with a technique referred as WALANT or wide-awake local anesthesia no tourniquet. Strong outcomes have continued to follow with each advancing technique.
In the prospective study by Bergum and colleagues, they note strong outcomes with minimal complications performing CTR surgery under ultrasound and local anesthesia only in the office. This technique continues to build on innovative efforts to optimize patient recovery and minimize costs with carpal tunnel syndrome. However, I would caution that such minimally invasive office procedures should still best be performed by orthopedists and hand surgeons in case of complications and/or the need to convert to an open case if clinical circumstances demand it.
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Bergum R, et al. Paper 42. Presented at: American Society for Surgery of the Hand Annual Meeting. Sept.30 - Oct. 2, 2021; San Francisco (hybrid meeting).
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