Chloé Dekimpe1, Olivier Andreani2, Olivier Camuzard3, Charles Raffaelli4, David Petrover5, Pauline Foti6, Nicolas Amoretti2. 1. Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France. dekimpe.chloe@gmail.com. 2. Diagnostic and Interventional Radiology Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France. 3. Hand, Wrist, Plastic and Reconstructive Surgery Unit, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France. 4. Diagnostic and Interventional Radiology Unit, Ultrasound Department, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06001, Nice, France. 5. Diagnostic and Interventional Radiology Unit, IMPC Bachaumont-Blomet RGDS, 6 rue Bachaumont, 75002, Paris, France. 6. Department of Biostatistics, Hôpital Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France.
Abstract
OBJECTIVE: The purpose was to evaluate, in a cadaveric cohort, the feasibility and the learning curve of ultrasound-guided percutaneous carpal tunnel release. MATERIALS AND METHODS: Fourteen carpal tunnel releases were carried out on unembalmed cadavers by a senior and a junior radiologist. Procedures were realized with an 18-MHz linear probe. An anatomical evaluation was first performed using ultrasound to detect any anatomical variant. After hydrodissection of the carpal tunnel with lidocaine, a 3-mm hook knife was introduced into the security zone to perform a retrograde section of the transverse carpal ligament (TCL) under ultrasound guidance. Anatomical dissection was performed for each wrist. The main evaluation criterion was the complete TCL section. The procedure duration (minutes), skin incision size (millimeters), the integrity of the median nerve, thenar motor branch, and palmar vascular arch were also evaluated. RESULTS: The senior operator was able to perform a complete release after training on three specimens and the junior operator after four specimens (p > 0.05). In most of the cases when complete release was not achieved, it was due to an incomplete section of the distal TCL (10 mm missing section on average). Mean duration time of procedure was 14 min (11 min for the senior versus 17 min for the junior, p > 0.05). Damage of neither the median nerve nor the vascular structure was observed. Mean size of the skin incision was 3 mm. CONCLUSION: The ultrasound-guided percutaneous release of the carpal tunnel is demonstrated to be a procedure with a rapid learning curve.
OBJECTIVE: The purpose was to evaluate, in a cadaveric cohort, the feasibility and the learning curve of ultrasound-guided percutaneous carpal tunnel release. MATERIALS AND METHODS: Fourteen carpal tunnel releases were carried out on unembalmed cadavers by a senior and a junior radiologist. Procedures were realized with an 18-MHz linear probe. An anatomical evaluation was first performed using ultrasound to detect any anatomical variant. After hydrodissection of the carpal tunnel with lidocaine, a 3-mm hook knife was introduced into the security zone to perform a retrograde section of the transverse carpal ligament (TCL) under ultrasound guidance. Anatomical dissection was performed for each wrist. The main evaluation criterion was the complete TCL section. The procedure duration (minutes), skin incision size (millimeters), the integrity of the median nerve, thenar motor branch, and palmar vascular arch were also evaluated. RESULTS: The senior operator was able to perform a complete release after training on three specimens and the junior operator after four specimens (p > 0.05). In most of the cases when complete release was not achieved, it was due to an incomplete section of the distal TCL (10 mm missing section on average). Mean duration time of procedure was 14 min (11 min for the senior versus 17 min for the junior, p > 0.05). Damage of neither the median nerve nor the vascular structure was observed. Mean size of the skin incision was 3 mm. CONCLUSION: The ultrasound-guided percutaneous release of the carpal tunnel is demonstrated to be a procedure with a rapid learning curve.
Entities:
Keywords:
Cadaver; Carpal tunnel syndrome; Learning curve; Median nerve; Ultrasound
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