Hand Surgery & Rehabilitation最新文献

{"title":"De Quervain’s disease: Ultrasound-guided release","authors":"Francisco Javier Ferreira Villanova ,&nbsp;Vincent Martinel ,&nbsp;Olivier Marès","doi":"10.1016/j.hansur.2025.102087","DOIUrl":"10.1016/j.hansur.2025.102087","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to evaluate the outcomes of a novel antegrade, ultrasound-guided release of the first extensor tendon compartment for treating De Quervain’s disease.</div></div><div><h3>Methods</h3><div>We conducted a retrospective, single-center study of 34 patients who underwent ultrasound-guided release of the first extensor compartment for clinically diagnosed De Quervain’s disease between June 2022 and December 2023. Inclusion criteria included age &gt;18 years and failure of conservative treatment (e.g., NSAIDs, physiotherapy, and steroid injection) for more than six weeks. Exclusion criteria were prior trigger thumb surgery and documented allergy to local anesthetics. Outcomes were assessed using pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, and complication rates.</div></div><div><h3>Results</h3><div>The mean VAS for pain improved from 7.4 to 1.1, and the QuickDASH score improved from 55 to 9.4 at the final follow-up. We recorded three minor complications and no major complications.</div></div><div><h3>Conclusion</h3><div>Ultrasound-guided surgical release of the first extensor compartment for De Quervain’s disease is a minimally invasive, technologically advanced, and effective treatment option.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102087"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radial nerve at Frohse's arcade: a new technique of release under total ultrasound guidance. First experience","authors":"Olivier Marès ,&nbsp;Javier Ferreira ,&nbsp;Sarah Pradel ,&nbsp;Vincent Martinel ,&nbsp;Camillo Chaves ,&nbsp;Thomas Apard","doi":"10.1016/j.hansur.2025.102089","DOIUrl":"10.1016/j.hansur.2025.102089","url":null,"abstract":"<div><div>Radial nerve compression at the arcade of Frohse is a rare but significant condition that typically presents with pain primarily after exertion and at night on the dorsal side of the forearm, more distally than tennis elbow pain, and weakness of the wrist extensors and the long fingers and thumb extensors. Traditional treatment often involves open surgery, resulting in significant scarring.</div><div>This study introduces a novel percutaneous radial nerve release technique under complete ultrasound guidance and highlights its efficacy and safety. The procedure involves identifying the entry point, lateral of the radial nerve, allowing for targeted release of the superficial fascia surrounding the supinator muscle without damaging nearby vascular or nerve structures.</div><div>A cadaveric study was performed on ten fresh-frozen specimens to validate the entry point and route, which successfully demonstrated complete fascial release without complications.</div><div>Preliminary clinical results from five patients showed complete resolution of symptoms associated with radial tunnel syndrome with no reported complications. The technique results in a significantly smaller incision (&lt;1 cm) compared to traditional methods (up to 10 cm) and can be performed under WALANT anesthesia, making it suitable for the outpatient setting.</div><div>This approach offers a minimally invasive alternative for patients with isolated posterior interosseous nerve compression and highlights the importance of ultrasound guidance in achieving optimal results. Because the technique requires a learning curve, it is recommended for surgeons with experience in ultrasound-guided procedures.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102089"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous ultrasound guided retrograde lacertus fibrosus release","authors":"Thomas Apard ,&nbsp;Vincent Martinel","doi":"10.1016/j.hansur.2025.102130","DOIUrl":"10.1016/j.hansur.2025.102130","url":null,"abstract":"<div><div>The purpose of this technical note is to present a microinvasive percutaneous ultrasound-guided release of the lacertus fibrosus of the biceps brachii for lacertus syndrome, i.e., median nerve entrapment at the elbow.</div><div>Using the Walant technique (wide awake local anesthesia and no tourniquet), the entry point is made with a 19G needle to introduce the hook distally from the distal border of the lacertus fibrosus. The hook is then slid along the pronator teres fascia to the proximal border of the lacertus fibrosus. The cut is ultrasound-guided from proximal to distal. The cut is effective when the back of the force is observed in the 3 targeted muscles (flexor carpi radialis, flexor pollicis longus and flexor digitorum profundus).</div><div>This minimally invasive surgical procedure is efficient in terms of lacertus fibrosus sectioning. Real-time ultrasound monitoring may improve safety. The technique could be considered as a new ultrasound-guided alternative to open surgery.</div><div>When performed superficially to the pronator teres muscle under WALANT anesthesia and percutaneously, ultrasound-guided lacertus fibrosus release may be an effective treatment for lacertus syndrome in the interventional ultrasound unit.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102130"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transverse ultrasound-guided fasciotomy in lateral epicondylitis","authors":"Vincent Martinel ,&nbsp;Franck Lapègue ,&nbsp;Aymeric Andre ,&nbsp;Olivier Marès","doi":"10.1016/j.hansur.2024.102075","DOIUrl":"10.1016/j.hansur.2024.102075","url":null,"abstract":"<div><div>Lateral epicondylitis is a very common form of tendinosis that may heal spontaneously. Diagnosis is mainly clinical. Treatment is usually non-operative. However, if conservative treatment fails, open or arthroscopic tenotomy of the epicondylar muscles may be an option. Ultrasound-guided percutaneous tenotomy may now be performed on the common epicondylar tendon close to the enthesis, with a success rate close to that of conventional surgery. For several years now, we have used a slightly different technique, involving ultrasound-guided fasciotomy of the extensor digitorum communis and extensor carpi radialis brevis muscles at the level of the radiohumeral joint. It may be performed under local anesthesia in the office. Ultrasound-guided hydro-dissection of the fascia is essential to facilitate the procedure and easily visualize the various anatomical structures. Fasciotomy can be performed with an ophthalmology scalpel, surgical knife or curved needle. This procedure is similar to arthroscopic techniques, but is significantly less expensive and with lower carbon footprint. It is safe and effective when a surgeon with experience in ultrasound-guided procedures performs it.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102075"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound guided Carpal tunnel release: The retrograde technique","authors":"Thomas Apard ,&nbsp;Jules Descamps ,&nbsp;Vincent Martinel","doi":"10.1016/j.hansur.2025.102132","DOIUrl":"10.1016/j.hansur.2025.102132","url":null,"abstract":"<div><div>Ultrasound-guided surgery is a new trend resulting from the introduction of high-frequency linear probes and higher-quality screens. Surgical treatment of carpal tunnel syndrome is increasingly being performed under ultrasound guidance. Knowledge of musculoskeletal ultrasound is, of course, essential. Several types of cutting instruments (miniature knife, Gigli saw or hook) and surgical approaches (wrist or palm) have been described. Ultrasonography allows the use of the wide awake and local anesthesia with no tourniquet (WALANT) technique in the outpatient setting. The purpose of this article is to report our experience with retrograde percutaneous ultrasound-guided techniques.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102132"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided radial nerve release for lateral intermuscular septum syndrome","authors":"Thomas Apard ,&nbsp;Vincent Martinel","doi":"10.1016/j.hansur.2025.102131","DOIUrl":"10.1016/j.hansur.2025.102131","url":null,"abstract":"<div><div>Radial nerve entrapment at the lateral intermuscular septum in the distal upper arm can cause debilitating pain and functional impairment. The nerve passes from the dorsal to the volar compartment through the LIS, approximately 8–10 cm proximal to the lateral epicondyle, making it susceptible to compression. Clinical signs include wrist drop, localized pain, and weakness in wrist and finger extension, often seen in manual laborers and athletes.</div><div>A minimally invasive, ultrasound-guided, percutaneous technique using local anesthesia and no tourniquet allows precise nerve decompression while preserving function. Hydrodissection under Doppler ultrasound ensures safety and avoids complications such as nerve palsy. This approach minimizes tissue disruption compared to traditional open decompression. Despite promising results, the technique remains under-researched, with no large-scale clinical trials available. Prospective studies with long-term follow-up are essential to establish the efficacy of this innovative, patient-centered technique.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102131"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided release of carpal tunnel syndrome — Anterograde technique","authors":"Carla Ricardo Nunes ,&nbsp;Olivier Marès ,&nbsp;Vincent Martinel","doi":"10.1016/j.hansur.2025.102091","DOIUrl":"10.1016/j.hansur.2025.102091","url":null,"abstract":"<div><div>Compression of the median nerve in the carpal tunnel is a frequent pathology with severe functional impact. An ultrasound-guided technique was developed to preserve structures, diminish scar fibrosis and enable fast return to full activity. Its advantages are safety and low additional cost.</div><div>Ultrasound-guided carpal tunnel release is indicated in moderate and severe carpal tunnel syndrome persisting after conservative treatment. A preoperative ultrasound scan is recommended to evaluate anatomy. Recurrent carpal tunnel syndrome, secondary carpal tunnel syndrome and anatomic variants compromising the safety of transverse carpal ligament division are contraindications.</div><div>The procedure is performed under local anesthesia without tourniquet. The entry point is a short transverse incision proximal to the wrist crease. The transverse carpal ligament is divided anterogradely, using a dedicated blade under ultrasound control, making sure no nerves, tendons or blood vessels are injured. The final step is to check that the division is complete. Early return to use of the hand is permitted.</div><div>Reports of similar techniques demonstrated early symptomatic relieve, favorable patient-reported outcome measures from within 1 week after surgery to 2 years’ follow-up, with early return to normal daily activity and work. The complications rate is low: many series showed no complications. Comparative studies between ultrasound-guided carpal tunnel release and the mini-open technique reported similar or greater and quicker symptom relief, less scar pain and better strength. Final functional results tend to be similar.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102091"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic exertional compartment syndrome in the forearm: Ultrasound-guided surgical technique","authors":"Jean Michel Cognet ,&nbsp;Jean Baptiste Facon ,&nbsp;Alexandre Faure ,&nbsp;Olivier Mares","doi":"10.1016/j.hansur.2025.102094","DOIUrl":"10.1016/j.hansur.2025.102094","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic exertional compartment syndrome of the forearm is most commonly associated with exercise. It presents as cramping after a few minutes of activity, requiring cessation of exercise. We describe an ultrasound-guided surgical technique for the treatment of forearm chronic exertional compartment syndrome.</div></div><div><h3>Anatomy and Pathophysiology</h3><div>The forearm consists of three compartments: the anterior, lateral, and dorsal compartments. These compartments are formed by the muscles of the forearm and are surrounded by a fibroelastic membrane composed of connective tissue. Repetitive activity in the forearm leads to an increase in muscle volume within a non-extensible compartment. This increase in pressure causes pain and cramping, forcing the individual to stop the activity. Diagnosis is based on measurement of intramuscular compartment pressures.</div></div><div><h3>Surgical Technique</h3><div>Surgical treatment involves performing a fasciotomy. This can be done through an incision along the length of the forearm or through a minimally invasive approach using endoscopic or ultrasound guidance. The ultrasound-guided technique uses two small entry points and a specialized knife. No post-operative immobilization is required, allowing patients to quickly resume their activities.</div></div><div><h3>Discussion</h3><div>Chronic exertional compartment syndrome of the forearm is a condition that is particularly common among motorcyclists. Diagnosis is based on a combination of a suggestive clinical presentation and pathological intramuscular pressure. Treatment may be conservative or surgical (fasciotomy). Fasciotomy can be performed using an open approach or a minimally invasive ultrasound-guided technique. Published studies on ultrasound-guided treatment report excellent results with a rapid return to sports activities after surgery.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102094"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided trigger thumb release","authors":"Francisco Javier Ferreira Villanova ,&nbsp;Vincent Martinel ,&nbsp;Olivier Marès","doi":"10.1016/j.hansur.2025.102084","DOIUrl":"10.1016/j.hansur.2025.102084","url":null,"abstract":"<div><div>The purpose of this study was to evaluate the results of a novel retrograde ultrasound-guided A1 pulley release technique for the treatment of trigger thumb.</div><div>We conducted a retrospective, single-center study of 42 patients who underwent ultrasound-guided A1 pulley release for clinically diagnosed trigger thumb between September 2022 and December 2023. All cases were graded according to the Green classification of trigger finger severity. Inclusion criteria were patients aged &gt;18 years who failed conservative treatment (non-steroidal anti-inflammatory drugs, physical therapy, or steroid injections) for at least six weeks. Exclusion criteria were previous trigger thumb surgery, metacarpophalangeal or trapeziometacarpal arthrodesis, and documented allergy to local anesthetics. Outcome measures were pain intensity (visual analog scale, VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores, and complication rates.</div><div>The mean age of the patients was 37.8 years (range: 27–72). Based on Green’s classification, we treated 5 grade I, 26 grade II, 6 grade IIIA, and 5 grade IIIB cases. At one month follow-up, all patients had resolution of the triggering. The mean VAS score improved significantly from 7.2 to 1.3 and the Quick-DASH score decreased from 51 to 9.1. There were no major complications.</div><div>Open A1 pulley release for trigger thumb is effective but carries risks to the palmar radial digital nerve, especially in open surgery. Alternative methods such as ultrasound-guided and percutaneous release offer similar results with fewer complications. Recovery is faster for trigger thumb (2 weeks) compared to trigger finger (5 weeks). Some patients may experience prolonged symptoms after surgery. Open surgery has a 12% complication rate and a 2.4% revision rate. Ultrasound-guided percutaneous release is safer and allows real-time visualization during the procedure.</div><div>Retrograde ultrasound-guided A1 pulley release is an effective and safe treatment for stenosing tenosynovitis of the flexor pollicis longus. It offers advantages over traditional approaches, including improved cosmetic outcomes, the absence of sutures, and the ability for patients to resume daily activities and light work immediately postoperatively.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102084"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterograde ultrasound guided lacertus fibrosus release at the elbow under WALANT – Technical note","authors":"Carla Ricardo Nunes ,&nbsp;Vincent Martinel ,&nbsp;Olivier Marès","doi":"10.1016/j.hansur.2025.102086","DOIUrl":"10.1016/j.hansur.2025.102086","url":null,"abstract":"<div><div>Dynamic compression of the median nerve under the lacertus fibrosus at the elbow causes pain and weakness. It is a frequently overlooked pathology and a cause of failed recovery after carpal tunnel release.</div><div>The purpose was to present a technical note on minimally invasive ultrasound-guided lacertus syndrome surgical treatment under WALANT.</div><div>We believe the technique is indicated in patients who present with a positive Hagert's triad of pain over the median nerve at the lacertus, weakness on testing of the flexor pollicis longus, second flexor digitorum profundus, and flexor carpi radialis, and a positive sensitive collapse test. Contraindications include static median nerve compression at the elbow and allergy to lidocaine.</div><div>The technique is preceded by local anesthesia, which is completed under ultrasound guidance for deeper or more proximal structures. The entry point is calculated proximal to the lacertus and the special knife is introduced through a 0.5 cm incision. The lacertus is divided anterogradely under ultrasound guidance. Full recovery of strength is evidenced by the completion of the division.</div><div>The patient returns to full activity within days to a week after surgery.</div><div>Minimally invasive, ultrasound-guided release allows for rapid return of full-strength motion with minimal scarring.</div></div>","PeriodicalId":54301,"journal":{"name":"Hand Surgery & Rehabilitation","volume":"44 ","pages":"Article 102086"},"PeriodicalIF":0.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}