Ultrasound Guided Carpal Tunnel Release Now Available

"Ultra-Minimally Invasive Carpal Tunnel Release" or Ultrasound Guided Carpal Tunnel Release (USGCTR) is Now Available at The Gold Coast Carpal Tunnel Clinic. This surgery is based on extensive world research. There have been numerous cadaver studies and clinical studies which have proven the safety and efficacy of USGCTR and Dr Maguire has written a Systematic Review of the Subject as a research paper for his Masters of Sports Medicine.

The technique used by Dr Maguire is that described by Rojo-Manaute et al (Rojo-Manaute JMM et al. Ultra-Minimally Invasive Sonographically Guided Carpal Tunnel Release Anatomic Study of a New Technique. Journal of Ultrasound in Medicine 2013;32(1):131–142). This group first undertook a cadaver study in 2013 where they tested the technique and also very accurately described the "SAFE ZONE" for Ultrasound Guided Carpal Tunnel Release (USGCTR) using Ultrasound and MRI Scans.

Based on their research Rojo-Manaute et al determined where it was safe to cut the transverse carpal ligament both in an axial and coronal plane. In 10 cadaver specimens using a 3mm "Hook Knife" the authors showed that all transverse carpal ligaments were completely divided and no nerves, vessels or tendons were injured.

In 2014 the same group published another study under Capa-Grasa et al in 2014 (Capa-Grasa A, Rojo-Manaute JM, Rodriguez FC, Martín JV. Ultra minimally invasive sonographically guided carpal tunnel release: an external pilot study. Orthop Traumatol Surg Res 2014; 100:287–292) In this Pilot study the authors assessed the feasibility of perfoming a randomised trial comparing Ulta-MIS CTR to Mini-Open CTR. They compared 20 patients in each group and showed the QuickDASH patient scores were significantly better in the Ultrasound Guided CTR group. 

The group concluded that a prospective trial was needed, however they stated:

“While a randomized trial is still needed for generalizing its clinical use, to our knowledge, there is currently no evidence to neither contraindicate nor withhold the use of Ultra-MIS in patients with symptomatic CTS and a positive electrodiagnostic tests.” 

Rojo-Manaute et al then published their "Landmark Paper" in 2016 (Rojo-Manaute JM et al. Ultra‐Minimally Invasive Ultrasound‐Guided Carpal Tunnel Release. Journal of Ultrasound in Medicine 2016;35(6):1149–1157) which is the most significant evidence to date validating the Ultrasound Guided Carpal Tunnel Release technique. The authors described the study as a “Single-centre individual parallel-group controlled-superiority randomised control trial”.

In the study the authors compared Ultra-Minimally Invasive CTR using a "Hook-Knife" through a 1mm incision to Mini-Open CTR through a 2cm wound in the palm. 

There were 92 patients in the study. Assessors were independent and blinded to the treatments by covering the wounds at examination. Treatments were randomised via concealed allocation from a computer-generated list. Two groups n=46 with 5 lost to follow-up per group left 41 in each group giving a total of 82 patients matched to age, symptom duration, work type, pre-op treatment and sex.

QuickDASH scores were 2.3 to 3.3 times lower in the Ultra-MIS CTR group for the first 6 months. These results were statistically significant (t test, xtest p<0.05).

The authors concluded that Ultra-Minimally Invasive CTR produced less postoperative morbidity and earlier return of function compared to Mini Open CTR. Both procedures offered similar neurologic recovery for the treatment of carpal tunnel syndrome.

This study was the first Randomised Controlled Trial (RCT) to compare true Ultrasound Guided Carpal Tunnel release (USGCTR) to any other established surgical treatment for CTS and the first real Level 1 Evidence for this procedure.

Based on the above research and other work Dr Maguire has been transitioning from (Endoscopic Carpal Tunel Release) ECTR to purely Ultrasound Guided Carpal Tunnel Release (USGCTR). Dr Maguire is now offering Ultrasound Guided Carpal Tunnel Release to his patients if he feels it is appropriate. There are some cases of carpal tunnel syndrome which still require open surgery. Dr Maguire still offers Endoscopic Carpal Tunnel release if patients request this technique.

© GC CTCT 2015