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Hall MM, Kliethermes SA, Henning PT, Hoffman DF, Mautner K, Obunadike E, Onishi K, Pourcho AM, Sellon JL, Chimenti R. Three-Month Complication Rate of Ultrasound-Guided Soft Tissue Surgical Procedures Across Six Sports Medicine Clinics. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2629-2641. [PMID: 37376744 DOI: 10.1002/jum.16298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVES To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications. METHODS A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates. RESULTS Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified. CONCLUSION This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.
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Affiliation(s)
- Mederic M Hall
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Stephanie A Kliethermes
- Department of Orthopaedics & Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - P Troy Henning
- Sports and Performance Medicine, Swedish Medical Center, Seattle, Washington, USA
| | - Douglas F Hoffman
- Departments of Orthopaedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Kenneth Mautner
- Department of Orthopedics and Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Ezi Obunadike
- Department of Orthopedics and Physical Medicine and Rehabilitation, Emory University, Atlanta, Georgia, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Adam M Pourcho
- Elite Sports Performance Medicine, Seattle, Washington, USA
| | - Jacob L Sellon
- Department of Orthopedic Surgery, Sports Medicine Division, Mayo Clinic, Rochester, Minnesota, USA
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa, USA
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Honis HR, Gruber H, Honold S, Konschake M, Moriggl B, Brenner E, Skalla-Oberherber E, Loizides A. Anatomical considerations of US-guided carpal tunnel release in daily clinical practice. J Ultrason 2023; 23:e131-e143. [PMID: 37732109 PMCID: PMC10508271 DOI: 10.15557/jou.2023.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/28/2023] [Indexed: 09/22/2023] Open
Abstract
Carpal tunnel syndrome is the most frequent compression neuropathy with an incidence of one to three subjects per thousand. As specific anatomical variations might lead to unintended damage during surgical interventions, we present a review to elucidate the anatomical variability of the carpal tunnel region with important considerations for daily clinical practice: several variants of the median nerve branches in and around the transverse carpal ligament are typical and must - similarly to the variant courses of the median artery, which may be found eccentric ulnar to the median nerve - be taken into account in any interventional therapy at the carpal tunnel. Unintended interference in these structures might lead to heavy arterial bleeding and, in consequence, even underperfusion of segments of the median nerve or, if neural structures such as variant nerve branches are impaired or even cut, severe pain-syndromes with a profound impact on the quality of life. This knowledge is thus crucial for outcome- and safety-optimization of different surgical procedures at the volar aspect of the wrist and surgical therapy of the carpal tunnel syndrome e.g., US-guided carpal tunnel release, as injury might result in dysfunction and/or pain on wrist motion or direct impact in the region concerned. For most variations, anatomical and surgical descriptions vary, as official classifications are still lacking.
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Affiliation(s)
- Hanne-Rose Honis
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Sarah Honold
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Innsbruck, Austria
| | | | - Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AES, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel) 2023; 13:diagnostics13061138. [PMID: 36980446 PMCID: PMC10046938 DOI: 10.3390/diagnostics13061138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.
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Affiliation(s)
- King Hei Stanley Lam
- The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
- Faculty of Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
- Correspondence: ; Tel.: +852-23720888
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Kenneth Dean Reeves
- Private Practice PM&R and Pain Management, 4840 El Monte, Roeland Park, KS 66205, USA
| | - Felice Galluccio
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan
- Fisiotech Lab. Studio, Rheumatology and Pain Management, 50136 Firenze, Italy
- Morphological Madrid Research Center (MoMaRC), 10107 Madrid, Spain
| | - Abdallah El-Sayed Allam
- Morphological Madrid Research Center (MoMaRC), 10107 Madrid, Spain
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Clinical Neurophysiology Fellowship, Arab Board of Health Specializations, Ministry of Health, Baghdad 61298, Iraq
| | - Philip W. H. Peng
- Department of Anesthesiology and Pain Medicine, The University of Toronto, Toronto, ON M5T 2S8, Canada
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Chou RC, Robinson DM, Homer S. Ultrasound-guided percutaneous carpal tunnel release: A systematic review. PM R 2023; 15:363-379. [PMID: 35254722 DOI: 10.1002/pmrj.12801] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/08/2022] [Accepted: 02/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Carpal tunnel syndrome (CTS) is the most common peripheral entrapment mononeuropathy. The purpose of this systematic review is to evaluate the reported clinical effectiveness and safety of ultrasound-guided percutaneous carpal tunnel release (USCTR) for the treatment of CTS. LITERATURE SURVEY PubMed, EMBASE, and ScienceDirect databases were queried from database inception to February 20, 2021, to identify clinical studies on USCTR. METHODOLOGY Two reviewers independently completed title, abstract, and full-text screening, and they extracted data in duplicate for analysis. Procedure techniques, outcome measures, and complications were descriptively analyzed. SYNTHESIS Eighty-seven studies were eligible for screening. Twenty studies (three randomized controlled trials, three prospective cohort studies, and 14 case series) met inclusion criteria, with a total of 1772 USCTR cases. The overall level of evidence was very low, with seven studies with at least moderate risk of bias. Thirteen studies exceeded the minimal clinically important difference (MCID) for the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SS) and Boston Carpal Tunnel Questionnaire Functional Status Scale (BCTQ-FS), and six studies exceeded the MCID for the Quick Disabilities of Arm, Shoulder & Hand (QDASH). Five studies reported statistically significant improvement in these functional outcome measures as early as the first week post-procedure. A major complication occurred in one patient who developed suspected compartment syndrome, and minor complications were reported in 24 patients. CONCLUSIONS Based on very low level of evidence, early studies suggest that USCTR may be an effective treatment for CTS, with potential for short post-procedure recovery times.
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Affiliation(s)
- Raymond C Chou
- Physical Medicine and Rehabilitation Division, Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - David M Robinson
- Sports Medicine Division, Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Scott Homer
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, Massachusetts, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Chen CH, Jaw FS, Hu JZ, Wu WT, Chang KV. Dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release: technical innovation and case study. Heliyon 2023; 9:e13107. [PMID: 36711298 PMCID: PMC9880394 DOI: 10.1016/j.heliyon.2023.e13107] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Abstract
Background Minimally invasive carpal tunnel release has recently emerged as the primary surgical approach for recalcitrant carpal tunnel syndrome. A major concern related to surgical failure with this technique is the incomplete release of the flexor retinaculum. Case presentation We developed a technique using dynamic ultrasound for evaluating the adequacy of median nerve decompression following minimally invasive carpal tunnel release. This novel imaging method was applied to two patients who showed significant symptom relief after the intervention. This case study also provides details of the dynamic ultrasound protocol and highlights the advantages of this technique. Conclusion Dynamic ultrasound imaging can be used to confirm the completeness of carpal tunnel decompression. A large-scale prospective trial should be conducted to validate whether additional dynamic ultrasound examination can improve the outcome of minimally invasive carpal tunnel release.
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Affiliation(s)
- Chien-Hua Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan,Clive Chen Clinic, Taichung, Taiwan
| | - Fu-Shan Jaw
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | | | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan,Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan,Corresponding author. Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan.
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Graesser EA, Dy CJ, Brogan DM. Future Considerations in the Diagnosis and Treatment of Compressive Neuropathies of the Upper Extremity. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022. [PMID: 37521547 PMCID: PMC10382897 DOI: 10.1016/j.jhsg.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Compressive neuropathies of the upper extremity are among the most common conditions seen by hand surgeons. The diagnoses of carpal tunnel syndrome and cubital tunnel syndrome have traditionally been made by a combination of history, physical examination, and electrodiagnostic testing. However, findings can be nonspecific and electrodiagnostic testing is invasive for the patient. The diagnosis of compressive neuropathies continues to evolve as technology advances, and newer diagnostic modalities predominantly focus on preoperative diagnostic imaging with ultrasound and magnetic resonance imaging/neurography. With the advent of cheaper, faster, and less invasive imaging, the future may bring a paradigm shift away from electrophysiology as the gold standard for the preoperative diagnosis of compressive neuropathies. Intraoperative imaging of nerve health is an emerging concept that warrants further investigation, whereas postoperative imaging of nerve recovery with ultrasound and magnetic resonance imaging currently has a limited role because of nonspecific findings and potential for misinterpretation. Advances in surgical treatment of compressive neuropathies appear to center around the use of imaging for less invasive neurolysis techniques and other adjunctive treatments with nerve decompression. The management of failed peripheral nerve decompressions and recurrent compressive neuropathies remains challenging.
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Abstract
BACKGROUND The purpose of this study was to determine the long-term safety and efficacy of carpal tunnel release (CTR) using ultrasound guidance in a group of patients treated by a single physician. METHODS The study group consisted of 76 consecutive CTRs performed on 47 patients between June 2017 and April 2019 for whom 1-year follow-up was available. All procedures were performed by the same operator using a single CTR technique. Outcomes included complications; Boston Carpal Tunnel Questionnaire symptom severity (BCTQ-SSS) and functional status (BCTQ-FSS) scores; Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores; and a 5-point global satisfaction score (4 = satisfied, 5 = very satisfied). RESULTS The 47 patients included 27 females and 20 males (ages 31-91 years). Twenty-five patients (50 hands) had simultaneous bilateral CTRs, 4 patients (8 hands) had staged bilateral CTRs, and 18 patients had unilateral CTRs. No complications occurred. Statistically and clinically significant reductions in BCTQ-SSS, BCTQ-FSS, and QDASH scores occurred by 1 to 2 weeks post-CTR and persisted at 1-year (mean 1-year changes vs. pre-CTR -2.11, -1.70, and -44.99, respectively; P < .001 for all). The mean global satisfaction score at 1-year was 4.63. CONCLUSIONS CTR using ultrasound (US) guidance is a safe and effective procedure that produces statistically and clinically significant improvements within 1 to 2 weeks postprocedure that persist to 1 year. Furthermore, simultaneous bilateral CTRs using US guidance are feasible and may be advantageous for patients who are candidates for bilateral CTR.
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Affiliation(s)
| | | | - Anthony E. Joseph
- OrthoIdaho, Pocatello, ID, USA
- Idaho State University, Pocatello, ID, USA
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Krigers A, Kriwan F, Freyschlag CF, Thomé C, Fritsch H. The distance between the distal margin of the flexor retinaculum and the radiocarpal joint as a landmark in CTS surgery: a cadaver study. Ann Anat 2022; 245:152003. [PMID: 36183941 DOI: 10.1016/j.aanat.2022.152003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The most frequent peripheral entrapment neuropathy is compression of the median nerve in the carpal tunnel, known as carpal tunnel syndrome. The most effective treatment is surgery, where the flexor retinaculum (FR1) is divided. Nevertheless, after this operation, a significant number of patients suffer from persistent symptoms due to incomplete FR distal release. It may be difficult to identify the distal boundary of the FR due to the minimal skin incision. We aimed to identify an anatomical landmark to avoid incomplete distal FR release. The radiocarpal (RC2) joint can be palpated, and lies in close proximity to the boundaries of the FR. Thus, the distance between the RC joint space and the distal FR margin - the RC-FR distance - could be a reliable and individual morphologic measurement from easily acquired regional anthropological measurements. METHODS During this study, 39 radiocarpal regions of 23 embalmed cadavers were dissected, and measurements were taken. Linear regression corresponding to the ulnar length and the RC-FR distance was established. RESULTS The mean RC-FR distance from the RC joint space to the distal FR margin was 3.8cm (95% CI 3.5-4.0), and the range was 2.3 to 5.1cm. This distance was 1.1cm (95% CI 0.8-1.4) longer in males than in females (p < 0.00001), and there were no side-specific differences. The individual projection of the distal FR margin in centimeters can be calculated by measurement of the ipsilateral ulnar length divided by 4 and reduced by 2.9, p < 0.005. CONCLUSIONS The side-equal and sex-specific position of the distal flexor retinaculum margin could be calculated from the palpable radiocarpal joint space based on the ipsilateral ulnar length.
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Affiliation(s)
- Aleksandrs Krigers
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria; Division of Clinical & Functional Anatomy, Medical University of Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria.
| | - Fabian Kriwan
- Division of Clinical & Functional Anatomy, Medical University of Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Helga Fritsch
- Division of Clinical & Functional Anatomy, Medical University of Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria
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9
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Bergum RA, Ciota MR. Office-Based Carpal Tunnel Release Using Ultrasound Guidance in a Community Setting: Long-Term Results. Cureus 2022; 14:e27169. [PMID: 35898805 PMCID: PMC9308387 DOI: 10.7759/cureus.27169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/05/2022] Open
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Fowler JR, Chung KC, Miller LE. Multicenter Pragmatic Study of Carpal Tunnel Release with Ultrasound Guidance. Expert Rev Med Devices 2022; 19:273-280. [PMID: 35236202 DOI: 10.1080/17434440.2022.2048816] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To report outcomes of patients who underwent carpal tunnel release with ultrasound guidance (CTR-US) in routine clinical practice. METHODS This was a multicenter post-market registry of patients treated with CTR-US. Main outcomes included the Quick Disabilities of Arm, Shoulder, and Hand Questionnaire (QDASH), Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), return to normal activities, return to work, and complications. RESULTS Of 535 patients who provided follow-up data, 373 (70%) were followed for 6 months post-treatment. Among these 373 patients (427 hands, mean age 55 years, 71% female), QDASH scores decreased by 30.8 points, BCTQ-SSS scores decreased by 1.6 points, and BCTQ-FSS scores decreased by 1.0 points at 6 months (all p<0.001). The median time to return to normal activities was 3 days and time to return to work was 5 days. Subgroup analysis revealed consistent outcomes regardless of age group, sex, body mass index, diabetes, tobacco use, worker compensation status, or procedure type (unilateral/bilateral simultaneous). No major neurovascular complications were reported. CONCLUSION Patients treated with CTR-US reported clinically meaningful improvements in symptoms and function, rapid return to normal activities, and minimal work absenteeism, with an excellent safety profile.
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Affiliation(s)
- John R Fowler
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin C Chung
- University of Michigan Comprehensive Hand Center, The University of Michigan Health System, Ann Arbor, MI, USA
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Abstract
During the past 2 decades, increased powerful and quality ultrasound devices have contributed to developing ultrasound surgery more specifically for the hand. Carpal tunnel release under ultrasound now is available as a safe technique. The procedure uses a specific device. A detailed surgical technique is presented. The role of sonography is emphasized. This article discusses the results of the 150 first cases. The author's experience is compared with other ultrasound-guided carpal tunnel release procedures. Outcome quality optimized by the ultra-mini-invasive approach and ultrasound should increase its use.
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Affiliation(s)
- Isabelle David
- Department of Hand Surgery, Belledonne Private Hospital, 83 Avenue Gabriel Péri, Saint-Martin d'Hères 38400.
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12
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de la Fuente J, Aramendi JF, Ibañez JM, Blasi M, Vazquez A, Aurrekoetxea JJ, Dávila F. Minimally invasive ultrasound-guided vs open release for carpal tunnel syndrome in working population: A randomized controlled trial. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:693-703. [PMID: 34046894 DOI: 10.1002/jcu.23019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To compare the clinical effectiveness of minimally invasive ultrasound (US)-guided vs open release for carpal tunnel syndrome. METHODS In an open randomized controlled trial, 47 employed patients were allocated to US-guided carpal tunnel release (USCTR) and 42 to an open carpal tunnel release (OCTR) procedure. The main outcome was symptom severity measured by the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ-S). Secondary outcomes were hand functionality (BCTQ-F), nerve conduction, two-point discrimination, handgrip and pinch strength, pain (visual analog scale), work leave and complications. For BCTQ-S and BCTQ-F, minimal clinically important differences (MCID) were also considered. Follow-up duration was 12 months. RESULTS Mixed model analyses detected no significant differences between the two treatment arms in BCTQ-S (P = .098) while BCTQ-F scores were significantly better in the USCTR group (P = .007). This benefit was, however, not supported by the MCID data. Remaining variables were similar in the two groups except pain which was lower in USCTR at 3 months follow-up. All variables but two-point discrimination showed significant improvement after 3 months. CONCLUSIONS Our findings reveal similar symptom relief benefits following OCTR or USCTR in these patients. The patients in our USCTR group, however, reported better hand functional status and less pain.
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Affiliation(s)
- Javier de la Fuente
- Department of Orthopedic Surgery, Clínica Pakea-Mutualia, San Sebastián, Spain
| | - Jose F Aramendi
- Primary Care Department, Clínica Pakea-Mutualia, San Sebastián, Spain
| | - Jose M Ibañez
- Department of Physical Medicine and Rehabilitation, Clínica Pakea-Mutualia, San Sebastián, Spain
| | - Marc Blasi
- Plastic Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alberto Vazquez
- Department of Occupational Medicine, Clínica Pakea-Mutualia, San Sebastián, Spain
| | | | - Fernando Dávila
- Department of Orthopedic Surgery, Clínica Pakea-Mutualia, San Sebastián, Spain
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Hebbard P, Thomas P, Fransch SV, Cichowitz A, Franzi S. Microinvasive Carpal Tunnel Release Using a Retractable Needle-Mounted Blade. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1451-1458. [PMID: 32951219 DOI: 10.1002/jum.15509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
We report 166 microinvasive ultrasound-guided carpal tunnel releases using the MICROi-Blade (Summit Medical Products, Inc, Sandy, UT), a needle-based tool for cutting under ultrasound guidance. The 6-month follow-up of the first 21 cases, including 5 bilateral releases, showed a progressive reduction in median pain scores, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale scores, and BCTQ Functional Status Scale scores. The median return to work was 7 days. The 3-month follow-up of 62 subsequent cases showed similar improvement in the BCTQ scores and return to work. There were no complications. This report supports the effectiveness of the technique.
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Affiliation(s)
- Peter Hebbard
- Northeast Health Wangaratta, Wangaratta, Victoria, Australia
- Ultrasound Education Unit, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Thomas
- Northeast Health Wangaratta, Wangaratta, Victoria, Australia
- Rural Clinical School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Adam Cichowitz
- Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Stephen Franzi
- Rural Clinical School, University of Melbourne, Melbourne, Victoria, Australia
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14
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Loizides A, Honold S, Skalla-Oberherber E, Gruber L, Löscher W, Moriggl B, Konschake M, Gruber H. Ultrasound-Guided Minimal Invasive Carpal Tunnel Release: An Optimized Algorithm. Cardiovasc Intervent Radiol 2021; 44:976-981. [PMID: 33629135 PMCID: PMC8172390 DOI: 10.1007/s00270-021-02789-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To present a safety-optimized ultrasound-guided minimal invasive carpal tunnel release (CTR) procedure. MATERIALS AND METHODS 104 patients (67 female, 37 male; mean age 60.6 ± 14.3 years, 95% CI 57.9 to 63.4 years) with clinical and electrophysiological verified typical carpal tunnel syndrome were referred for a high-resolution ultrasound of the median nerve and were then consecutively assigned for an ultrasound-guided CTR after exclusion of possible secondary causes of carpal tunnel syndrome such as tumors, tendovaginitis, ganglia and possible contraindications (e.g., crossing collateral vessels, nerve variations). Applying a newly adapted and optimized algorithm, basing on the work proposed by Petrover et al. CTR was performed using a button tip cannula which has several safety advantages: On the one hand, the button tip cannula acts as a blunt and atraumatic guiding splint for the subsequent insertion of the hook-knife, and on the other hands, it serves as a "hydro-inflation"-tool, i.e., a fluid-based expansion of the working-space is warranted during the whole procedure whenever needed. RESULTS In all patients, successful releases were confirmed by the depiction of a completely transected transverse carpal ligament during and in the postoperative ultrasound-controls two weeks after intervention. All patients reported markedly reduction of symptoms promptly after this safety-optimized ultrasound-guided minimal invasive CTR and at the follow-up examination. No complications were evident. CONCLUSION The here proposed optimized algorithm assures a reliable and safe ultrasound-guided CTR and thus should be taken into account for this minimal invasive interventional procedure.
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Affiliation(s)
- Alexander Loizides
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Sarah Honold
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Leonhard Gruber
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Löscher
- Department of Neurology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Moriggl
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria
| | - Marko Konschake
- Institute of Clinical and Functional Anatomy, Medical University Innsbruck, Muellerstrasse 59, 6020, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Wise A, Pourcho AM, Henning PT, Latzka EW. Evidence for Ultrasound-Guided Carpal Tunnel Release. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-020-00305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Clinical Outcomes in Carpal Tunnel Syndrome. AJR Am J Roentgenol 2020; 217:460-468. [PMID: 32876476 DOI: 10.2214/ajr.20.24383] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND. Ultrasound guidance allows performance of carpal tunnel release with smaller incisions and quicker recovery than traditional open or endoscopic surgery. OBJECTIVE. The purpose of this study was to evaluate the long-term effectiveness of ultrasound-guided carpal tunnel release in improving function and discomfort in patients with carpal tunnel syndrome. METHODS. Retrospective review was conducted of 61 ultrasound-guided carpal tunnel release procedures performed on 46 patients (15 bilateral procedures) with clinically diagnosed carpal tunnel syndrome. The procedures were performed with a single-use transection device and local anesthesia at an outpatient radiology office. Patients answered three questionnaires (Quick Disabilities of the Arm, Shoulder, and Hand [QDASH] and two parts of the Boston Carpal Tunnel Syndrome Questionnaire-the symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS] scales) to assess the function of and discomfort in the affected wrist immediately before and 2 weeks and at least 1 year after the procedure. Higher scores indicated increasing disability. Patients also answered a global satisfaction question at follow-up. Preprocedure and postprocedure scores were compared by paired Wilcoxon signed rank tests. RESULTS. The 46 patients (25 women, 21 men; mean age, 60.6 years; range, 21-80 years) had median preprocedure scores of 45.4 for QDASH, 3.2 for BCTSQ-SS, and 2.5 for BCTSQ-FS. The median scores 2 weeks after the procedure were 22.5 for QDASH, 1.7 for BCTSQ-SS, and 1.9 for BCTSQ-FS. All scores decreased (p < .001) from preprocedure scores and surpassed reference standards for clinically important difference in scores. Follow-up questionnaires obtained for 90% (55/61) of wrists a median of 1.7 years (range, 1.0-2.8 years) after the procedure showed further declines (p < .001) in median scores: 2.3 for QDASH, 1.2 for BCTSQ-SS, and 1.1 for BCTSQ-FS. At long-term follow-up evaluation, 96% (52/54) of wrists had lower QDASH and 98% (53/54) had lower BCTSQ (average of BCTSQ-SS and BCTSQ-FS) scores compared with the preprocedure scores. Among the patients who participated in the survey, 93% (37/40) were satisfied or very satisfied with the long-term outcomes. No immediately postoperative complications occurred. Two patients needed surgical intervention 8 and 10 days after surgery, one for infection after injury and one for posttraumatic compartment syndrome. CONCLUSION. Ultrasound-guided carpal tunnel release quickly improves hand function and reduces hand discomfort; improvement persists beyond 1 year. CLINICAL IMPACT. Ultrasound-guided carpal tunnel release may be a safe, effective, and less invasive alternative to traditional surgery.
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Chappell CD, Beckman JP, Baird BC, Takke AV. Ultrasound (US) Changes in the Median Nerve Cross-Sectional Area After Microinvasive US-Guided Carpal Tunnel Release. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:693-702. [PMID: 31659789 DOI: 10.1002/jum.15146] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/18/2019] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To document changes in the median nerve cross-sectional area (CSA) in the proximal carpal tunnel region after ultrasound (US)-guided carpal tunnel release (CTR). METHODS Prospective data were collected on 23 consecutive patients (37 wrists) treated with US-guided CTR by the primary author using the same office-based microinvasive technique. Ultrasound was used to measure the largest CSA of the median nerve in the proximal carpal tunnel region both preoperatively and postoperatively. The primary outcome measure was the change in the preoperative versus 6- to 10-week postoperative median nerve CSA. RESULTS The mean CSA of the median nerve decreased from 16.08 to 12.75 mm2 at 6 to 10 weeks after US-guided CTR (P < .001). During the same period, the mean Boston Carpal Tunnel Questionnaire (BCTQ) symptom score decreased from 3.23 to 1.67 (P < .001), and mean BCTQ functional score decreased from 2.49 to 1.47 (P < .001), both exceeding minimal clinically important differences. Although the primary end point was the median nerve CSA at 6 to 10 weeks, statistically significant reductions in the median nerve CSA, as well as BCTQ scores, were also observed as early as 2 to 4 weeks after US-guided CTR (median nerve CSA, 12.40 mm2 ; BCTQ symptom score, 2.00; BCTQ functional score, 1.75; all P ≤ .03). CONCLUSIONS To our knowledge, this investigation was the largest to date examining changes in the proximal median nerve CSA after US-guided CTR. Statistically significant reductions in the proximal median nerve CSA were observed within 6 to 10 weeks after ultrasound-guided CTR. These reductions were similar to those previously reported for open and endoscopic CTR and validate the ability of US-guided CTR to relieve median nerve compression.
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Affiliation(s)
| | | | - Brian C Baird
- Stony Brook Southampton Hospital, Southampton, New York, USA
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18
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Boettcher BJ, Hollman JH, Stuart MJ, Finnoff JT. Ultrasound‐Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study. PM R 2020; 12:1113-1119. [DOI: 10.1002/pmrj.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | - John H. Hollman
- Department of Physical Medicine and Rehabilitation Mayo Clinic College of Medicine and Science Rochester MN
| | - Michael J. Stuart
- Department of Orthopedic Surgery Mayo Clinic College of Medicine and Science Rochester MN
| | - Jonathan T. Finnoff
- Department of Physical Medicine and Rehabilitation Mayo Clinic College of Medicine and Science Rochester MN
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Joseph AE, Leiby BM, Beckman JP. Clinical Results of Ultrasound-Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:441-452. [PMID: 31449326 DOI: 10.1002/jum.15120] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/26/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the safety and efficacy of ultrasound-guided carpal tunnel release (USCTR) in a consecutive group of patients treated by a single primary care sports medicine physician. METHODS The study group consisted of 35 USCTRs performed on 22 consecutive patients for whom clinical outcomes were available before USCTR and at 1 to 2 weeks, 1 month, and 3 months after USCTR. All procedures were performed by the same operator using a single USCTR technique. Outcomes included complications, Quick Disabilities of the Arm, Shoulder, and Hand scores, Boston Carpal Tunnel Questionnaire symptom severity and functional status scores, and a 5-point global satisfaction score. RESULTS The 22 patients included 13 female and 9 male patients (ages 31-82 years). Eleven patients (22 wrists) had bilateral simultaneous USCTRs; 2 patients (4 wrists) had staged bilateral USCTRs; and 9 patients had unilateral USCTRs. No complications occurred in any patient. Statistically and clinically significant reductions in Quick Disabilities of the Arm, Shoulder, and Hand scores and Boston Carpal Tunnel Questionnaire symptom severity and functional status scores occurred by 1 to 2 weeks after USCTR (mean 1- to 2-week changes, -29.23, -1.74, and -1.18, respectively), and further improvements occurred during the 3-month follow-up period (mean 3-month changes, -51.11, -2.29, and -1.91; P < .0001 for all values versus before USCTR). Mean global satisfaction scores at 1 to 2 weeks and 3 months were 4.63 and 4.66. CONCLUSIONS Ultrasound-guided CTR is a safe and effective procedure that can be performed by an experienced primary care sports medicine physician and typically results in significant improvements within the first 2 weeks after the procedure. Furthermore, bilateral simultaneous USCTRs are feasible and may provide significant advantages for patients who are candidates for bilateral CTRs.
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Affiliation(s)
- Anthony E Joseph
- OrthoIdaho, Pocatello, Idaho, USA
- Department of Family Medicine, Idaho State University, Pocatello, Idaho, USA
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Boettcher BJ, Hollman JH, Stuart MJ, Finnoff JT. Ultrasound-Guided Cutting Wire Release of the Proximal Adductor Longus Tendon: A Feasibility Study. Orthop J Sports Med 2019; 7:2325967119866010. [PMID: 31489333 PMCID: PMC6710695 DOI: 10.1177/2325967119866010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Adductor longus tendinopathy is a well-known etiology of chronic groin pain in elite athletes. Surgery is indicated for those who fail conservative treatment. No studies to date have evaluated the feasibility of an ultrasound-guided release of the proximal adductor longus tendon. Purpose/Hypothesis: The primary aim of this study was to determine the feasibility of an ultrasound-guided selective adductor longus release with a cutting wire. A secondary aim was to determine safety by avoiding injury to adjacent structures. We hypothesized that the proximal adductor longus tendon can be released under ultrasound guidance with a cutting wire without injury to adjacent neurovascular or genitourinary structures. Study Design: Descriptive laboratory study. Methods: Ten adductor longus tendons (5 cadaveric specimens) from 4 males and 1 female between 76 and 89 years of age with a mean body mass index of 21.9 kg/m2 (range, 16.8-29.6 kg/m2) were used during this study. A single experienced physician sonographer performed ultrasound-guided proximal adductor longus tendon releases on all cadaveric specimens using a cutting wire. Dissection was performed by a second physician to determine the completeness of the tendon transections and to detect injury to adjacent neurovascular or genitourinary structures. Results: All 10 adductor longus tendons were transected. Eight of 10 transections were complete, whereas in 2 transections, >99% of the tendon was transected. There were no injuries to adjacent genitourinary or neurovascular structures. Conclusion: Ultrasound-guided adductor tendon release is feasible and safe in a cadaveric model. Further translational research should be performed to determine whether these results can be replicated in the clinical setting. Clinical Relevance: Adductor longus tendinopathy frequently requires surgical intervention and prolonged time away from sport. The present study suggests that a selective adductor longus tendon release can be performed with ultrasound guidance. This procedure warrants further translational research to explore its use in clinical practice.
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Affiliation(s)
| | - John H Hollman
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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