Ultrasound-Guided Modified Thread Carpal Tunnel Release for Carpal Tunnel Syndrome: A Pilot Study

Jaewon Kim; Jae Min Kim; Hae-Yeon Park; In Jong Kim

doi:10.1055/a-2280-3507

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Ultraschall Med 2025; 46(01): 57-65
DOI: 10.1055/a-2280-3507

Original Article

Ultrasound-Guided Modified Thread Carpal Tunnel Release for Carpal Tunnel Syndrome: A Pilot Study

Ultraschallgesteuerter modifizierter Thread Carpal Tunnel Release bei Karpaltunnelsyndrom: Eine Pilotstudie

Autor*innen

Jaewon Kim

¹Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Ringgold ID: RIN183696)
Jae Min Kim

¹Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Ringgold ID: RIN183696)
Hae-Yeon Park

²Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (Ringgold ID: RIN46667)
In Jong Kim

³Department of Rehabilitation Medicine, Howareyou Rehabilitation Clinic, Seoul, Republic of Korea

Abstract

Purpose This study aimed to investigate the effectiveness and safety of modified thread carpal tunnel release (mTCTR) using Smartwire-01 in patients with carpal tunnel syndrome (CTS).

Materials and Methods Patients with CTS who required CTR were enrolled. Symptom severity and functional status were assessed using the Boston Carpal Tunnel Syndrome Questionnaire-Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), and pain was assessed using a numerical rating scale (NRS) at 4, 8, and 12 weeks after mTCTR. The scores were compared with the pre-procedural scores. The electrophysiologic study and median nerve cross-sectional area (CSA) measurements at the wrist before and 12 weeks after mTCTR were compared.

Results A total of 11 patients were included. No adverse effects were reported throughout the study period. The NRS, BCTQ-SSS, and BCTQ-FSS scores significantly improved at 4 weeks after mTCTR, and this improvement persisted throughout the follow-up period (NRS and BCTQ-SSS, P < 0.001; BCTQ-FSS, P = 0.012). After 12 weeks, the latency and velocity of the median sensory nerve action potential significantly improved, compared with those before mTCTR (latency, 5.4 ± 1.3 to 4.7 ± 1.1 ms, P = 0.01; velocity 27.8 ± 6.8 to 31.8 ± 7.4 m/s, P = 0.019). No significant change was observed in the median nerve CSA before and after mTCTR.

Conclusion mTCTR using Smartwire-01 is a safe and effective procedure and a possible alternative to surgery.

Zusammenfassung

Ziel Ziel dieser Studie war es, die Wirksamkeit und Sicherheit des modifizierten Thread-Carpal-Tunnel-Release (mTCTR) bei Patienten mit Karpaltunnel-Syndrom (KTS) unter Verwendung von Smartwire-01 zu untersuchen.

Material und Methoden Patienten mit KTS, die CTR benötigten, wurden eingeschlossen. Der Schweregrad der Symptome und der funktionelle Status wurden mit dem „Boston Carpal Tunnel Syndrome Questionnaire“ mittels Symptom-Severity-Scale (BCTQ-SSS) und Functional-Status-Scale (BCTQ-FSS) beurteilt. Die Schmerzen wurden 4, 8 und 12 Wochen nach dem mTCTR durch die numerische Bewertungsskala (NRS) beurteilt. Die Werte wurden mit denen vor dem Eingriff verglichen. Die elektrophysiologische Untersuchung und die Messungen der Querschnittsfläche des N. medianus (CSA, cross-sectional area) am Handgelenk vor mTCTR und 12 Wochen danach wurden verglichen.

Ergebnisse Es wurden insgesamt 11 Patienten eingeschlossen. Während des gesamten Studienzeitraums wurden keine Nebenwirkungen gemeldet. Die NRS-, BCTQ-SSS- und BCTQ-FSS-Scores verbesserten sich 4 Wochen nach mTCTR signifikant, und diese Verbesserung hielt während des gesamten Nachbeobachtungszeitraums an (NRS und BCTQ-SSS, p<0,001; BCTQ-FSS, p=0,012). Nach 12 Wochen verbesserten sich Latenz und Geschwindigkeit des Aktionspotenzials des N. medianus im Vergleich zu den Werten vor mTCTR signifikant (Latenz 5,4 ± 1,3 auf 4,7 ± 1,1 ms, p=0,01; Geschwindigkeit 27,8 ± 6,8 auf 31,8 ± 7,4 m/s, p=0,019). Vor und nach mTCTR wurde keine signifikante Veränderung des CSA des N. medianus beobachtet.

Schlussfolgerung Der mTCTR mit Smartwire-01 ist ein sicheres und wirksames Verfahren und eine mögliche Alternative zur Operation.

Keywords

carpal tunnel syndrome - thread carpal tunnel release - ultrasound-guided procedure - median neuropathy

Volltext

Referenzen

References
1 Atroshi I, Gummesson C, Johnsson R. et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282: 153-158
2 Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58: 289-294
3 Fajardo M, Kim SH, Szabo RM. Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am 2012; 37: 1599-1605
4 Cima RR, Lackore KA, Nehring SA. et al. How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution. Surgery 2011; 150: 943-949
5 Boya H, Ozcan O, Ozteki NH. Long-term complications of open carpal tunnel release. Muscle Nerve 2008; 38: 1443-1446
6 Kim PT, Lee HJ, Kim TG. et al. Current approaches for carpal tunnel syndrome. Clin Orthop Surg 2014; 6: 253-257
7 Palmer AK, Toivonen DA. Complications of endoscopic and open carpal tunnel release. J Hand Surg Am 1999; 24: 561-565
8 Guo D, Tang Y, Ji Y. et al. A non-scalpel technique for minimally invasive surgery: percutaneously looped thread transection of the transverse carpal ligament. Hand (N Y) 2015; 10: 40-48
9 Nakamichi K, Tachibana S. Ultrasonographically assisted carpal tunnel release. J Hand Surg Am 1997; 22: 853-862
10 Park HY, Kim JM, Kim IJ. et al. Cadaveric Study of Thread Carpal Tunnel Release Using Newly Developed Thread, With a Histologic Perspective. Ann Rehabil Med 2023; 47: 19-25
11 Park J, Kim IJ, Park HY. et al. A clinical study of thread carpal tunnel release with a newly developed thread: A retrospective pilot study. PLoS One 2022; 17: e0276630
12 Kumar N, Chandan SK, Jalan D. et al. Ultrasound-guided interventions in primary carpal tunnel syndrome: perineural injection to thread carpal tunnel release. Br J Radiol 2023; 96: 20230552
13 Chou RC, Robinson DM, Homer S. Ultrasound-guided percutaneous carpal tunnel release: A systematic review. PM&R 2023; 15: 363-379
14 Mende K, Kamphuis SJ, Schmid V. et al. Early Postoperative Recovery after Modified Ultra-Minimally Invasive Sonography-Guided Thread Carpal Tunnel Release. Journal of Personalized Medicine 2023; 13: 610
15 Leiby BM, Beckman JP, Joseph AE. Long-term clinical results of carpal tunnel release using ultrasound guidance. Hand 2022; 17: 1074-1081
16 Biglari F, Sabaghzadeh A, Sadighi M. et al. Initial Outcomes of a Novel Modification of Looped Threaded Carpal Tunnel Release Method. Tech Hand Up Extrem Surg 2023; 27: 132-135
17 Asserson DB, North TJ, Rhee PC. et al. Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study. Journal of Hand Surgery (European Volume) 2022; 47: 359-363
18 Guo D, Guo D, Guo J. et al. A clinical study of the modified thread carpal tunnel release. Hand 2017; 12: 453-460
19 North TJ, Asserson DB, Shin AY. et al. Thread carpal tunnel release: a retrospective review of the first 300 cases performed at a tertiary medical centre. J Hand Surg Eur Vol 2023; 48: 936-937
20 Gould D, Kulber D, Kuschner S. et al. Our surgical experience: open versus endoscopic carpal tunnel surgery. The Journal of Hand Surgery 2018; 43: 853-861
21 Petrover D, Richette P. Treatment of carpal tunnel syndrome: from ultrasonography to ultrasound guided carpal tunnel release. Joint Bone Spine 2018; 85: 545-552
22 Zieske L, Ebersole GC, Davidge K. et al. Revision carpal tunnel surgery: a 10-year review of intraoperative findings and outcomes. The Journal of hand surgery 2013; 38: 1530-1539
23 Henry BM, Zwinczewska H, Roy J. et al. The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis. PLoS One 2015; 10: e0136477
24 Burnham RS, Loh EY, Rambaransingh B. et al. A Controlled Trial Evaluating the Safety and Effectiveness of Ultrasound-Guided Looped Thread Carpal Tunnel Release. Hand (N Y) 2021; 16: 73-80
25 Latzka EW, Henning PT, Pourcho AM. Sonographic changes after ultrasound-guided release of the transverse carpal ligament: a case report. PM&R 2018; 10: 1125-1129
26 Stecco C, Macchi V, Lancerotto L. et al. Comparison of transverse carpal ligament and flexor retinaculum terminology for the wrist. J Hand Surg Am 2010; 35: 746-753
27 Guo D, Guo D, Harrison R. et al. A cadaveric study using the ultra-minimally invasive thread transection technique to decompress the superficial peroneal nerve in the lower leg. Acta Neurochir (Wien) 2019; 161: 2133-2139
28 McCool L, Tonkin B, Guo D. et al. Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis. Hand (N Y) 2021; 16: 644-649
29 Kang M, Nam YS, Kim IJ. et al. A Cadaveric Study of Thread Cubital Tunnel Release with Newly Developed Threads. J Korean Neurosurg Soc 2022; 65: 307-314
30 Gruber H, Honold S, Skalla E. et al. Novel Minimally Invasive Ultrasound-Guided Cubital Tunnel Release: Extending the Scope?. Ultraschall Med 2022; 43: 403-405