Variations anatomiques après libération percutanée écho-guidée du canal carpien

IF 0.9 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2024-12-01 DOI:10.1016/j.hansur.2024.101857

Amandine Ledoux , Fabian Moungondo

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引用次数: 0

Abstract

While the gold standard of carpal tunnel release (CTR) is open surgery, new and less invasive procedures have emerged. Sonographically-guided percutaneous surgery is the newest technique described.

The aim of this study was to quantify whether percutaneous incision of the transverse carpal ligament (TCL) can lead to anatomical modification and how these changes may explain postoperative clinical manifestations.

In a prospective, non-controlled study, 21 patients with carpal tunnel syndrome (CTS) confirmed by electromyography were assessed. These patients were evaluated preoperatively and postoperatively after ultrasound-guided percutaneous CTR at 1,3,6 months.

Clinical and ultrasound evaluation were performed.

Sonographic measurements consisted in median nerve cross sectional areas (CSA) over and at the carpal tunnel (CT), interapophyseal distance between the hook of the hamate and the trapezium tubercle to assess the opening of the CT and distance between the TCL and the CT bottom to assess bowstringing effect.

Clinical assessment consisted in: pillar pain (PP), grip strength, key pinch, and other variables.

A three-dimensional surface scan was obtained: we measured the antero-posterior thickness of the hand and CSA at CT level in transversal plane, to quantify the swelling of the palm heel at the four perioperative time.

Ultrasound measurements showed a significant difference between preoperative and postoperative states for most of the collected datas. However, no significant difference was found for the trapezio-hamatal inter-apophyseal distance.

Almost all clinical quantitative variables showed significant changes between each perioperative time. The comparison of variables at one month postoperatively showed a significant correlation between grip and key pinch strength.

There was a highly significant correlation between PP and thickness of the hand at CT level at each perioperative time.

The lack of significant change in inter-apophyseal distance before and after surgery suggests an absence of opening of the carpal arch postoperatively in this sample.

Because the grip strength improved few weeks after the surgery with persistant increased distance between the CT bottom and the TCL, bowstringing does not appear to be the cause of strength loss observed after CTR.

A significant link between PP and the swelling at the palm heel was observed post-operatively, however this effect remains difficult to be distinguished from the effect of time alone.

We can conclude that there are some anatomical changes after percutaneous sonographically guided CTR.

Postoperative outcome is favorable: we observe the regain of force at 3 months and a diminution of the swelling of the hand at 6 months.

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.