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Kang J, Wu W, Kong X, Su Y, Liu D, Li C, Gao N, Wang Y, Zheng C, Weng Y, Wang L. Improved visualization of median, ulnar nerves, and small branches in the wrist and palm using contrast-enhanced magnetic resonance neurography. Ther Adv Neurol Disord 2024; 17:17562864241239739. [PMID: 38532801 PMCID: PMC10964438 DOI: 10.1177/17562864241239739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Background Magnetic resonance imaging of peripheral nerves in the wrist and palm is challenging due to the small size, tortuous course, complex surrounding tissues, and accompanying blood vessels. The occurrence of carpal palmar lesions leads to edema, swelling, and mass effect, which may further interfere with the display and identification of nerves. Objective To evaluate whether contrast-enhanced magnetic resonance neurography (ceMRN) improves the visualization of the morphology and pathology of the median, ulnar nerves, and their small branches in the wrist and palm. Design An observational study. Methods In total 57 subjects, including 36 volunteers and 21 patients with carpal palmar lesions, were enrolled and underwent ceMRN and non-contrast MRN (ncMRN) examination at 3.0 Tesla. The degree of vascular suppression, nerve visualization, diagnostic confidence, and lesion conspicuity was qualitatively assessed by two radiologists. Kappa statistics were obtained for inter-reader agreement. The signal-to-noise ratio, contrast ratio (CR), and contrast-to-noise ratio (CNR) of the median nerve were measured. The subjective ratings and quantitative measurements were compared between ncMRN and ceMRN. Results The inter-reader agreement was excellent (k > 0.8) for all qualitative assessments and visualization assessment of each nerve segment. Compared with ncMRN, ceMRN significantly improved vascular suppression in volunteers and patients (both p < 0.001). The ceMRN significantly enhanced nerve visualization of each segment (all p < 0.05) and diagnostic confidence in volunteers and patients (both p < 0.05). The ceMRN improved lesion conspicuity (p = 0.003) in patients. Quantitatively, ceMRN had significantly higher CRs of nerve versus subcutaneous fat, bone marrow, and vessels and CNR of nerve versus vessel than ncMRN (all p < 0.05). Conclusion The ceMRN significantly improves the visualization of peripheral nerves and pathology in the wrist and palm by robustly suppressing the signals of fat, bone marrow, and especially vessels in volunteers and patients.
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Affiliation(s)
- Jiamin Kang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenjun Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yu Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dingxi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chungao Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nan Gao
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youzhi Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuxiong Weng
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lixia Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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2
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Bertelli JA, Buitrago ER, Shah HR. Base of the Third Metacarpal as a Palpable and Reliable Landmark for Identifying the Median Nerve's Thenar Branch. J Hand Surg Am 2023; 48:1174.e1-1174.e6. [PMID: 37480915 DOI: 10.1016/j.jhsa.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/07/2023] [Accepted: 05/24/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE The objective of this study was to investigate whether the base of the third metacarpal can predict the location of the thenar branch (TB) of the median nerve and the accuracy of palpating the base of the third metacarpal. METHODS In 15 patients with ulnar nerve lesions around the elbow, we transferred the opponens motor branch to repair the deep terminal division of the ulnar nerve (DTDUN). Before surgery, we located the TB by palpating the base of the third metacarpal volarly. During surgery, we placed three needles at the following places: one at the entrance of the TB into the abductor pollicis brevis, another at the point where the TB contacted the thenar muscles, and third at the DTDUN's trajectory over the third metacarpal. We obtained fluoroscopic images and measured distances between the needles and structures with image software. We also examined the relationship between the TB, DTDUN, and the volar tubercle of the base of the third metacarpal in cadaver hands. Finally, we invited 22 surgeons to palpate the base of the third metacarpal on volunteer hands and verified their accuracy using fluoroscopy. RESULTS During surgery, after dissection and palpation of the TB, under fluoroscopy, we confirmed that the palpable bone prominence was the base of the third metacarpal. In cadaver dissections, we observed the TB crossing the volar tubercle of the base of the third metacarpal superficially from proximal to distal and from ulnar to radial. The DTDUN was, on average, 14 mm distal to the base of the third metacarpal distal limit. In total, 19 of the 22 surgeons correctly identified the base of the third metacarpal and consequently the trajectory of the TB. CONCLUSIONS The palpable base of the third metacarpal can be used to determine the trajectory of both the TB and DTDUN. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Affiliation(s)
- Jayme A Bertelli
- Department of Surgical Techniques, Federal University of Santa Catarina, Florianópolis, Brazil; Department of Orthopedics and Traumatology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil.
| | - Edna R Buitrago
- Division of Hand Surgery, Pontifical Xavierian University, Cali, Colombia; Laboratory of Human Anatomy, Industrial University of Santander, Santander, Colombia
| | - Harsh R Shah
- Department of Orthopedics and Traumatology, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil; Department of Plastic, Hand and Reconstructive Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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3
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Ekhtiari S, Phillips M, Dhillon D, Shahabinezhad A, Bhandari M. Understanding the Learning Curve of Carpal Tunnel Release With Ultrasound Guidance: A Review. Cureus 2023; 15:e41938. [PMID: 37588328 PMCID: PMC10425578 DOI: 10.7759/cureus.41938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/18/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and can be treated through carpal tunnel release (CTR) if nonoperative treatments fail. CTR can be performed through a variety of techniques, including traditional open, mini-open, endoscopic, and CTR with ultrasound guidance (CTR-US). The evidence on endoscopic CTR is mixed, due to a higher potential for nerve injury with endoscopic CTR compared to traditional open CTR. CTR-US offers the potential advantage of allowing the visualization of all key anatomical structures, combined with a very small incision and minimal soft tissue insult. As with any ultrasonographic technique or procedure, the learning curve needs to be considered for any provider considering adopting CTR-US. However, literature on ultrasound use around the wrist, including early evidence on the learning curve of CTR-US specifically, demonstrates this skill can be learned relatively quickly by providers with a wide range of prior experience in ultrasound and CTR. Overall, there is a need for high-quality studies comparing different CTR techniques, particularly CTR-US, as it offers the potential for considerable cost savings.
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Affiliation(s)
- Seper Ekhtiari
- Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Mark Phillips
- Health Research Methodology, McMaster University, Hamilton, CAN
| | - Dalraj Dhillon
- Faculty of Health Sciences, McMaster University, Hamilton, CAN
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Daniels SP, De Tolla JE, Azad A, Petchprapa CN. Nerve Imaging in the Wrist. Semin Musculoskelet Radiol 2022; 26:140-152. [PMID: 35609575 DOI: 10.1055/s-0042-1742393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Neuropathic symptoms involving the wrist are a common clinical presentation that can be due to a variety of causes. Imaging plays a key role in differentiating distal nerve lesions in the wrist from more proximal nerve abnormalities such as a cervical radiculopathy or brachial plexopathy. Imaging complements electrodiagnostic testing by helping define the specific lesion site and by providing anatomical information to guide surgical planning. This article reviews nerve anatomy, normal and abnormal findings on ultrasonography and magnetic resonance imaging, and common and uncommon causes of neuropathy.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Jadie E De Tolla
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Ali Azad
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York University, New York, New York
| | - Catherine N Petchprapa
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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Asghar A, Patra A, Ravi KS, Tubbs RS, Kumar A, Naaz S. Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta-analysis. Clin Anat 2022; 35:946-952. [PMID: 35489054 DOI: 10.1002/ca.23900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/06/2022]
Abstract
As the median nerve enters the carpal tunnel, it is a single nerve that soon bifurcates into lateral and medial branches into the hand. If the bifurcation is proximal to the carpel tunnel, a bifid median nerve results. Carpal tunnel syndrome is often associated with a bifid median nerve with or without a persistent median artery. Individual keywords and MeSH phrases were searched in the Google Scholar, SCOPUS, and PubMed databases. Full texts were then collected and assessed for suitability. The prevalence of bifid median nerve at the wrist joint in normal and carpal tunnel syndrome wrists (pre-canal part) and the mean difference between groups were recorded. Only human data were used to test the findings. The pooled odds ratio (with minimal heterogeneity) was 1.50 [1.17-1.93, 95% CI]. The bifid median nerve cross-sectional area (CSA) was significantly greater than that of a solitary median nerve in normal wrists. The mean difference in CSA between the two was 1.50 mm2 [0.56-2.45 mm2 , 95% CI] without heterogeneity (i2 = 0). Sex and laterality distributions scarcely differed between the two types of wrists. Owing to the insufficiency of data, the relationships with mean height and weight were not examined. There was a 50% greater incidence of bifid median nerves in carpal tunnel syndrome patients than in normal subjects. A bifid median nerve increases the mean CSA at the wrist joint by 1.5 mm2 . These findings indicate that the bifid median nerve is an anatomical risk factor for carpal tunnel syndrome. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Adil Asghar
- Associate Professor, Dept of Anatomy, AIIMS, Patna, India
| | - Apurba Patra
- Assistant Professor, Dept of Anatomy, AIIMS, Bathinda, India
| | | | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, Grenada
| | - Ashutosh Kumar
- Assistant Professor, Dept of Anatomy, AIIMS, Patna, India
| | - Shagufta Naaz
- Associate Professor, Dept of Anaesthesiology, AIIMS, Patna, India
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6
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Madani A, Créteur V, Bianchi S. Atlas of Sonographic Anatomy of the Hand and Wrist. Hand Clin 2022; 38:1-17. [PMID: 34802601 DOI: 10.1016/j.hcl.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Accurate knowledge of the technique of ultrasonographic (US) examination and of normal US appearance is a prerequisite for a successful US examination of the wrist and hand. In this article, we describe our standard US examination as well as the normal US findings of the hand and wrist.
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Affiliation(s)
- Afarine Madani
- Service de Radiologie, Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, Brussels 1070, Belgium
| | - Viviane Créteur
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, 808, Route de Lennik, Brussels 1070, Belgium.
| | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie médicale, 40a route de Malagnou, Geneva 1208, Switzerland
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Abstract
Diagnostic ultrasound in the diagnosis of carpal tunnel syndrome is firmly established. Preoperative evaluation is based on quantitative parameters such as measurement of the pathologically enlarged cross-sectional area of the nerve. The value of postoperative ultrasound lies in the visualization of the anatomy and the conclusions that can be drawn from it. It focuses on the semiquantitative sonographic parameters of nerve compression. Nerve lesions and persistent strictures can be visualized and clearly localized. In recurrent disease, the primary focus is to dynamically exclude postoperative scarring, which results in a reduction of nerve gliding.
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Affiliation(s)
- Sebastian Kluge
- Handchirurgie Seefeld, Seefeldstrasse 27, Zurich 8008, Switzerland; Department of Hand Surgery, Klinik Impuls, Bahnhofstraße 137, Wetzikon 8620, Switzerland.
| | - Martin Langer
- Department of Trauma, Hand and Reconstructive Surgery, University of Munster, Waldeyerstraße 1, Munster 48149, Germany
| | - Thomas Schelle
- Department of Neurology, Klinikum Dessau-Rosslau, Auenweg 38, Dessau-Rosslau 06847, Germany
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8
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Blum AG, van Holsbeeck MT, Bianchi S. Thumb Injuries and Instabilities. Part 2: Spectrum of Lesions. Semin Musculoskelet Radiol 2021; 25:355-365. [PMID: 34450660 DOI: 10.1055/s-0041-1730414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The motor function of the thumb and its alignment with regard to the hand make it particularly vulnerable to trauma. Pathology encountered in this joint is varied, and imaging techniques play a crucial role in the diagnosis and characterization of injury. Despite advances in imaging technology, acute thumb injuries remain a challenge for radiologists. Currently, standard radiography and ultrasonography are frequently used first-line imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations. Magnetic resonance imaging may be used to optimally characterize soft tissues and bone marrow. In this article, we cover the most common traumatic injuries: fractures, dislocations, collateral ligament injuries of the metacarpophalangeal joint, as well as soft tissue lesions.
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Affiliation(s)
- Alain G Blum
- Guilloz Imaging Department, CHRU of Nancy, University of Lorraine, Nancy, France.,Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, Vandœuvre-lès-Nancy, France
| | | | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie médicale, Geneva, Switzerland.,Service de Radiologie, Hôpitaux Universitaires de Genève, Geneva 14, Switzerland
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9
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Blum AG, van Holsbeeck MT, Bianchi S. Thumb Injuries and Instabilities. Part 1: Anatomy, Kinesiology, and Imaging Techniques of the Thumb. Semin Musculoskelet Radiol 2021; 25:346-354. [PMID: 34374068 DOI: 10.1055/s-0041-1730397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The unique anatomical characteristics of the thumb offer a broad range of motion and the ability to oppose thumb and finger, an essential function for grasping. The motor function of the thumb and its orientation make it particularly vulnerable to trauma. Pathologic lesions encountered in this joint are varied, and imaging techniques play a crucial role in injury detection and characterization. Despite advances in diagnostic accuracy, acute thumb injuries pose a challenge for the radiologist. The complex and delicate anatomy requires meticulous and technically flawless image acquisition. Standard radiography and ultrasonography are currently the most frequently used imaging techniques. Computed tomography is most often indicated for complex fractures and dislocations, and magnetic resonance imaging may be useful in equivocal cases. In this article, we present the relevant anatomy and imaging techniques of the thumb.
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Affiliation(s)
- Alain G Blum
- Guilloz Imaging Department, CHRU of Nancy, University of Lorraine, Nancy, France.,Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, Vandœuvre-lès-Nancy, France
| | | | - Stefano Bianchi
- CIM SA, Cabinet d'imagerie Médicale, Geneva, Switzerland.,Service de Radiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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10
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Dos Santos Silva J, de Barros LFP, de Freitas Souza R, Mendonça SM, Costa FM, Landeiro JA, Lopes FCR, Acioly MA. "Million dollar nerve" magnetic resonance neurography: first normal and pathological findings. Eur Radiol 2021; 32:1154-1162. [PMID: 34363135 DOI: 10.1007/s00330-021-08213-0] [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: 05/16/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate prospectively the feasibility of magnetic resonance neurography (MRN) in identifying the anatomical characteristics of thenar muscular branch (TMB) of the median nerve, also known as the "million dollar nerve," in patients and controls. METHODS Thirteen patients affected by carpal tunnel syndrome (CTS) and four healthy controls had their hands scanned on a 3-T MR imaging scanner for TMB visualization. Median nerve anatomical variations were classified into four groups according to Poisel's classification system modified by Lanz. TMB signal intensity and diameter were assessed for the diagnosis of neuropathy. RESULTS TMB was successfully identified in all patients and subjects by using MRN. The most suitable pulse sequences to identify and measure nerve diameter were 3D DW-PSIF and T2-FS-TSE. The axial oblique and sagittal oblique planes are complementary in demonstrating its entire course. TMB had mostly an extraligamentous course with radial side origin (93.8%, each). All patients experienced increased T2 signal intensity (p < 0.001) and thickened nerves. Mean TMB diameters were 1.27 ± 0.21 mm (range, 1.02-1.74 mm) and 0.87 ± 0.16 mm (0.73-1.08 mm) (p = 0.008) in the patient and control groups, respectively. CONCLUSION MRN is a reliable imaging technique for identification and anatomical characterization of TMB in patients affected by CTS. This innovative imaging workup may therefore be included in the preoperative evaluation of patients scheduled for carpal tunnel release, especially in CTS with TMB involvement or even in isolated TMB neuropathy. KEY POINTS • Magnetic resonance neurography allows precise visualization of the thenar muscular branch of the median nerve. • Thenar muscular branch anatomical variations can be correctly identified. • Preoperative scanning can contribute to reducing the risk of iatrogenic injuries during carpal tunnel release, especially in carpal tunnel syndrome with thenar muscular branch involvement or even in isolated thenar muscular branch neuropathy.
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Affiliation(s)
| | | | - Renan de Freitas Souza
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | | | - José Alberto Landeiro
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Fernanda Cristina Rueda Lopes
- Division of Radiology, DASA, Rio de Janeiro, Brazil.,Division of Radiology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Marcus André Acioly
- Division of Neurosurgery, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil. .,Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
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Abstract
LEARNING OBJECTIVES After reading this article and viewing the videos, the participant should be able to: 1. Recognize the following five wrist operations as consistent options for different wrist injuries: carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis. 2. Know the state-of-the-art of these five procedures. 3. State the indications of each operation. 4. List the surgical steps of these five procedures. SUMMARY The wrist is a complex joint that concentrates different types of tissues (e.g., bone, cartilage, ligaments, nerves, vessels) and a broad different spectrum of diseases. Treatment of wrist injuries has improved during recent years, mainly because of improvement in strategy, techniques, microsurgical equipment, understanding anatomy and improvements in technology. In this article, we present the five operations (i.e., carpal tunnel release, medial femoral condyle bone flap for scaphoid nonunion associated with carpal collapse and avascular necrosis, scaphocapitate arthrodesis for Kienböck disease, percutaneous screw fixation of nondisplaced scaphoid fracture, and four-corner arthrodesis) that have consistently given good outcomes in patients suffering from different wrist injuries/maladies.
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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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13
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Sato K, Murakami K, Mimata Y, Takahashi G, Doita M. Supraretinacular endoscopic carpal tunnel release: A safe alternative method for treatment of carpal tunnel syndrome. J Orthop Surg (Hong Kong) 2021; 29:2309499021993407. [PMID: 33641536 DOI: 10.1177/2309499021993407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Supraretinacular endoscopic carpal tunnel release (SRECTR) is a technique in which an endoscope is inserted superficial to the flexor retinaculum through a subcutaneous tunnel. The benefits of this method include a clear view for the surgeon and absence of median nerve compression. Surgeons can operate with a familiar view of the flexor retinaculum and median nerve downward, similar to open surgery. This study aimed to investigate the learning curve for SRECTR, an alternate method for carpal tunnel release, and evaluate its complications and the functional outcomes using a disposable commercial kit. METHODS We examined the open conversion rates and complications associated with SRECTR in 200 consecutive patients performed by two surgeons. We compared the operative time operated by a single surgeon. We evaluated outcomes in 191 patients according to Kelly's grading system. Patients' mean follow-up period was 12.7 months. RESULTS Nine patients required conversion to open surgery. There were no injuries to the nerves and tendons and no hematoma or incomplete dissection of the flexor retinaculum. The operative times varied between 11 and 34 minutes. We obtained the following results based on Kelly's grading of outcomes: excellent in 116, good in 59, fair in 13, and poor in 3 patients. CONCLUSIONS We found no patients with neurapraxia, major nerve injury, flexor tendon injury, superficial palmar arch injury, and hematoma. Although there was a learning curve associated with SRECTR, we performed 200 consecutive cases without neurovascular complications. This method may be a safe alternative to minimally invasive carpal tunnel surgery.
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Affiliation(s)
- Kotaro Sato
- Department of Orthopaedic Surgery, 12833Iwate Medical University, Idaidori, Yahaba-cho, Shiwa-Gun, Iwate, Japan
| | - Kenya Murakami
- Department of Orthopaedic Surgery, 12833Iwate Medical University, Idaidori, Yahaba-cho, Shiwa-Gun, Iwate, Japan
| | - Yoshikuni Mimata
- Department of Orthopaedic Surgery, 12833Iwate Medical University, Idaidori, Yahaba-cho, Shiwa-Gun, Iwate, Japan
| | - Gaku Takahashi
- Department of Critical Care Medicine, 12833Iwate Medical University, Idaidori, Yahaba-cho, Shiwa-Gun, Iwate, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, 12833Iwate Medical University, Idaidori, Yahaba-cho, Shiwa-Gun, Iwate, Japan
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14
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Picasso R, Zaottini F, Pistoia F, Carobbio A, Ascoli A, Barabino E, Perez MM, Parrinello G, Peretti G, Martinoli C. High-resolution ultrasound of the marginal mandibular branch of the facial nerve: Normal appearance and pathological findings in a postsurgical case series. Head Neck 2021; 43:2571-2579. [PMID: 33885202 DOI: 10.1002/hed.26720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study was to validate high-resolution ultrasound (US) as an imaging modality able to map the normal marginal mandibular nerve (MMN) and recognize its abnormalities in the postoperative setting. METHODS The ability of US to recognize the MMN was first tested by injecting latex under US guidance on three fresh frozen cadavers. Then, a standardized scanning protocol was established on 20 healthy volunteers based on appropriate landmarks. Finally, a postsurgical series of three patients with MMN abnormalities were examined with US. RESULTS In the cadaveric study, US-guided latex injection provided identification of the MMN. In healthy volunteers, US was able to recognize the MMN for a segment of 3.4 ± 1.2 cm in length. Pathologic abnormalities of the MMN were detected and characterized in three patients. CONCLUSIONS High-resolution US is a valuable diagnostic tool to identify the MMN and might have potential for detecting its pathologic changes.
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Affiliation(s)
- Riccardo Picasso
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Zaottini
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Pistoia
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Carobbio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Emanuele Barabino
- Interventional Angiography, Ospedale Santa Corona, Pietra Ligure, Italy
| | - Maribel Miguel Perez
- Unidad de Anatomía y Embriología Humana, Departamento de Patología y Terapéutica Experimental, Facultad de Medicina y Ciencias de la Salud (Campus de Bellvitge), Universitat de Barcelona, Barcelona, Spain
| | | | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Interdisciplinary Department of Surgical and Integrated Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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15
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Corte EL, Gelmi CAE, Acciarri N. Carpal tunnel syndrome caused by the entrapment of a bifid Lanz IIIA Type anatomical variant of median nerve: A case report and systematic literature review. Surg Neurol Int 2021; 12:37. [PMID: 33598353 PMCID: PMC7881513 DOI: 10.25259/sni_765_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Carpal tunnel syndrome (CTS) is the most common entrapment peripheral neuropathy. Median nerve may present several anatomical variations such as a high division or bifid median nerve (BMN). A thorough knowledge of the normal anatomy and variations of the median nerve at the wrist are fundamental to reduce complications during carpal tunnel release. Case Description: A 63-year-old man with CTS underwent preoperative ultrasound that showed the entrapment of the median nerve and disclosed a BMN Lanz IIIA Type anatomical variation at the carpal tunnel. During the surgery, the anatomical variant of a BMN at the wrist has been visualized. Both nervous rami entirely occupied the carpal canal and this may have predisposed to the development of the entrapment syndrome. Nor persistent median artery, or other associated abnormalities, have been identified. At the 6 months follow-up control, the patient referred a good surgical recovery with complete resolution of the preoperative symptoms of the median nerve entrapment. Conclusion: A rare case of Lanz IIIA BMN Type at the wrist has been encountered in a patient with a CTS and a systematic review and practical considerations have been presented with the aim of raising awareness to the neurosurgical community of a such rare variant that could be encountered during carpal tunnel release procedures. CTS may be caused by the entrapment of a BMN Lanz IIIA Type anatomical variant of median nerve. Preoperative US would help to identify such patients to reduce risk of iatrogenic injuries.
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Affiliation(s)
- Emanuele La Corte
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Clarissa A E Gelmi
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nicola Acciarri
- Neurosurgery Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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16
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A Preligamentous Variant of the Thenar Motor Branch of the Median Nerve. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00029. [PMID: 33725702 PMCID: PMC7546834 DOI: 10.5435/jaaosglobal-d-20-00029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/09/2020] [Indexed: 11/18/2022]
Abstract
We report a rare variant of the thenar motor branch (TMB) of the median nerve. A preligamentous TMB was discovered during revision carpal tunnel release in a 49-year-old man. The prevalence and characteristics of TMB variations are discussed. The literature describing iatrogenic injury to the TMB variants, surgical treatment, and preoperative screening tools is reviewed. Recognition of anatomic variants of the TMB is essential considering notable consequences of iatrogenic injury.
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17
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Kunc V, Štulpa M, Feigl G, Neblett C, Kunc V, Kachlík D. The superficial anatomical landmarks are not reliable for predicting the recurrent branch of the median nerve. Surg Radiol Anat 2020; 42:939-943. [PMID: 32333089 DOI: 10.1007/s00276-020-02475-x] [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: 10/26/2019] [Accepted: 04/13/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The variability of the recurrent branch (RB) of the median nerve lends itself to an increased risk of injury when performing the minimally invasive approach for carpal tunnel release without its direct visualization. This risk is less so when it is released via the more invasive open approach as the RB can be easily identified, but the drawback is that of longer postoperative patient recovery time. Therefore, performing these releases via the less invasive approach should be more favorable for patients providing it could be done safely. Hence with there being a positive link between the hypertrophy of the thenar musculature and the course of RB according to previous studies. METHODS We dissected 28 hands of 14 donated bodies fixed using Thiel's method to try to demonstrate these findings of the associations among the RB, palmar creases and other superficial anatomical landmarks. Fisher's exact test was conducted to verify the relationship between those structures statistically. RESULTS Statistically significant links were found between the type of the RB and the type of the palmar creases (p value = 0.0094) and between the RB type and the palmaris longus muscle presence (p value = 0.028). CONCLUSION It was inferred that palmar creases and other superficial anatomical landmarks listed in the text could not be used to predict the variability of the RB and the choice of mini-invasive approach should not be based on their course.
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Affiliation(s)
- Vojtech Kunc
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, Motol, 150 06, Prague, Czech Republic
| | - Michal Štulpa
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, Motol, 150 06, Prague, Czech Republic
| | - Georg Feigl
- Institute of Anatomy, Medical University Graz, Graz, Austria
| | - Carlos Neblett
- Department of Surgery, Anaesthesia, Radiology and Emergency Medicine, University of the West Indies, Kingston, Jamaica
| | - Vladimír Kunc
- Department of Computer Science, Czech Technical University, Prague, Czech Republic
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Úvalu 84, Motol, 150 06, Prague, Czech Republic.
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18
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Ultrasound-guided percutaneous release of the carpal tunnel: comparison of the learning curves of a senior versus a junior operator. A cadaveric study. Skeletal Radiol 2019; 48:1803-1809. [PMID: 31114970 DOI: 10.1007/s00256-019-03207-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose was to evaluate, in a cadaveric cohort, the feasibility and the learning curve of ultrasound-guided percutaneous carpal tunnel release. MATERIALS AND METHODS Fourteen carpal tunnel releases were carried out on unembalmed cadavers by a senior and a junior radiologist. Procedures were realized with an 18-MHz linear probe. An anatomical evaluation was first performed using ultrasound to detect any anatomical variant. After hydrodissection of the carpal tunnel with lidocaine, a 3-mm hook knife was introduced into the security zone to perform a retrograde section of the transverse carpal ligament (TCL) under ultrasound guidance. Anatomical dissection was performed for each wrist. The main evaluation criterion was the complete TCL section. The procedure duration (minutes), skin incision size (millimeters), the integrity of the median nerve, thenar motor branch, and palmar vascular arch were also evaluated. RESULTS The senior operator was able to perform a complete release after training on three specimens and the junior operator after four specimens (p > 0.05). In most of the cases when complete release was not achieved, it was due to an incomplete section of the distal TCL (10 mm missing section on average). Mean duration time of procedure was 14 min (11 min for the senior versus 17 min for the junior, p > 0.05). Damage of neither the median nerve nor the vascular structure was observed. Mean size of the skin incision was 3 mm. CONCLUSION The ultrasound-guided percutaneous release of the carpal tunnel is demonstrated to be a procedure with a rapid learning curve.
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Bianchi S, Becciolini M, Urigo C. Ultrasound Imaging of Disorders of Small Nerves of the Extremities: Less Recognized Locations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2821-2842. [PMID: 31025409 DOI: 10.1002/jum.15014] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
Ultrasound is a well-proven imaging modality for showing peripheral nerve disorders and guiding perineural injections. The aim of this review is to focus on small peripheral nerve abnormalities, which are usually not recognized by sonologists. In fact, most of these small nerves have a tiny diameter (<2 mm), and their anatomy is less familiar. We describe the most common causes of small peripheral nerve disorders, providing an accurate description of their anatomic locations and relationships with adjacent structures; we also focus on technical hints that may help in their evaluation.
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Affiliation(s)
| | | | - Carlo Urigo
- London Northwest University Healthcare Trust, London, England
- Studio Radiologico Urigo, Sassari, Italy
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20
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Sergeant AC, Badr S, Saab M, Demondion X, Cotten A, Jacques T. Carpal tunnel ultrasound: is the "safe zone" on the ulnar side of the median nerve really avascular? Eur Radiol 2019; 30:887-894. [PMID: 31468160 DOI: 10.1007/s00330-019-06416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Numerous publications have studied the regional anatomy of the carpal tunnel to define a "safe zone" to reduce the risk of perioperative neurovascular complications. This zone, located between the ulnar neurovascular bundle and the median nerve, is considered to be safe mainly because of the absence of vascular structures. This study aims to assess the presence of arterioles within this area using superb microvascular imaging (SMI). MATERIALS AND METHODS The images from patients who underwent a bilateral routine wrist ultrasound with SMI, between January 28 and February 28, 2019, were retrospectively reviewed by two radiologists to evaluate the presence and location of arterioles in the safe zone. In addition, cadaveric wrists injected with intra-arterial red latex underwent dissection of the carpal tunnel. RESULTS The images from 27 patients (54 wrists) were reviewed. In the safe zone, arterioles were seen superficial to the retinaculum in 36 wrists (36/54; 66.7%) and deep to the retinaculum in 21 wrists (21/54; 38.9%). The arterioles located deep to the retinaculum were more frequently found close to the median nerve (21/54; 38.9%) than to the ulnar artery (9/54; 16.7%). In five cadaveric wrists, arterioles were detected superficial to the retinaculum in 3 wrists (3/5; 60%) and deep to the retinaculum in 2 wrists (2/5; 40%). CONCLUSION Arterioles can be seen in the safe zone both superficial and deep to the flexor retinaculum. Deep to the retinaculum, they are mainly observed in the proximal aspect of the carpal tunnel and more frequently close to the median nerve. KEY POINTS • Superb microvascular imaging (SMI) enables the visualization of arterioles within the "safe zone" of the carpal tunnel (visible both superficial and deep to the flexor retinaculum). • Arterioles were more frequently observed in the proximal aspect of the carpal tunnel. • Deep to the retinaculum, arterioles were more frequently seen in proximity to the median nerve.
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Affiliation(s)
- Anne-Charlotte Sergeant
- Department of Musculoskeletal Radiology, Lille University Hospital, Lille, France.,Department of Radiology, University Hospital of Poitiers, Poitiers, France
| | - Sammy Badr
- Department of Musculoskeletal Radiology, Lille University Hospital, Lille, France
| | - Marc Saab
- Department of Orthopaedic surgery, Lille University Hospital, Lille, France.,Lille University School of Medicine, Lille, France.,Laboratory of Anatomy, Lille University School of Medicine, Lille, France
| | - Xavier Demondion
- Department of Musculoskeletal Radiology, Lille University Hospital, Lille, France.,Lille University School of Medicine, Lille, France.,Laboratory of Anatomy, Lille University School of Medicine, Lille, France
| | - Anne Cotten
- Department of Musculoskeletal Radiology, Lille University Hospital, Lille, France.,Lille University School of Medicine, Lille, France
| | - Thibaut Jacques
- Department of Musculoskeletal Radiology, Lille University Hospital, Lille, France. .,Lille University School of Medicine, Lille, France.
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21
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Partial anterior tunnel syndrome: a retrospective analysis of ultrasound findings in four surgically proven cases. Skeletal Radiol 2019; 48:807-812. [PMID: 30215106 DOI: 10.1007/s00256-018-3056-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/16/2018] [Accepted: 08/27/2018] [Indexed: 02/02/2023]
Abstract
We present the cases of four patients (two men and two women, mean age of 48.5 years) with surgically confirmed partial anterior tarsal syndrome, diagnosed by ultrasound. All patients reported pain in the dorsal aspect of the forefoot radiating to the first intermetatarsal space. Ultrasound showed compression of the medial branch of the deep fibular nerve by the extensor hallucis brevis tendon at the level of the Lisfranc joint, associated with a hypoechoic neuroma. The ultrasound allowed a correct diagnosis to be obtained, which was not evident from clinical examination or by standard radiographs (four patients) or MRI (three patients). Surgery confirmed the sonographic findings, and all patients showed complete recovery.
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Davies J, Fallon V, Kyaw Tun J. Ultrasound-guided percutaneous compartment release: a novel technique, proof of concept, and clinical relevance. Skeletal Radiol 2019; 48:959-963. [PMID: 30570711 PMCID: PMC6476821 DOI: 10.1007/s00256-018-3134-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ultrasound-guided thread release (USGTR) is a minimally invasive technique with excellent clinical outcomes currently used in clinical practice to divide the transverse carpal ligament in carpal tunnel syndrome. The purpose of this study is to determine whether this technique can be modified for use in large anatomical compartments in soft embalmed cadaveric models. MATERIALS AND METHODS Two operators adapted the USGTR technique for use in muscular compartments of the forearms and legs in a single soft embalmed cadaver. An iterative approach was used to adapt and improve the technique for use in large compartments, using equipment readily available in most radiology departments. RESULTS The USGTR technique was successfully modified and both operators were able to accurately divide fascial layers over distances of up to 30 cm using the modified technique. Fascial division was confirmed with ultrasound and dissection. CONCLUSIONS This adapted technique can successfully be used to divide fascial planes over longer distances than is currently achieved in clinical practice. The improved outcomes associated with USGTR at the carpal tunnel may therefore also be achievable in fasciotomy procedures in larger anatomical compartments. Further study is required to investigate the effects of this modified USGTR technique on intracompartmental pressure.
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Affiliation(s)
- Joseph Davies
- Royal London Hospital, Bart’s Health NHS Trust, London, E1 1BB UK
| | | | - Jimmy Kyaw Tun
- Royal London Hospital, Bart’s Health NHS Trust, London, E1 1BB UK
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Petrover D, Hakime A, Silvera J, Richette P, Nizard R. Ultrasound-Guided Surgery for Carpal Tunnel Syndrome: A New Interventional Procedure. Semin Intervent Radiol 2018; 35:248-254. [PMID: 30402007 DOI: 10.1055/s-0038-1673360] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Carpal tunnel syndrome (CTS) may be treated surgically if medical treatment fails. The classical approach involves release of the flexor retinaculum by endoscopic or open surgery. Meta-analyses have shown that the risk of nerve injury may be higher with endoscopic treatment. The recent contribution of ultrasound to the diagnosis and therapeutic management of CTS opens new perspectives. Ultrasound-guided carpal tunnel release via a minimally invasive approach enables the whole operation to be performed as a percutaneous radiological procedure. The advantages are a smaller incision compared with classical techniques; great safety during the procedure by visualization of anatomic structures, particularly variations in the median nerve; and realization of the procedure under local anesthesia. These advantages lead to a reduction in postsurgical sequelae and more rapid resumption of daily activities and work. Dressings are removed by the third day postsurgery. Recent studies seem to confirm the medical, economic, and aesthetic benefits of this new approach.
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Affiliation(s)
- David Petrover
- Centre Imagerie Medicale Bachaumont Paris Centre (IMPC Bachaumont-Blomet Ramsay GDS), Paris, France
| | - Antoine Hakime
- Centre Imagerie Medicale Bachaumont Paris Centre (IMPC Bachaumont-Blomet Ramsay GDS), Paris, France
| | - Jonathan Silvera
- Centre Imagerie Medicale Bachaumont Paris Centre (IMPC Bachaumont-Blomet Ramsay GDS), Paris, France
| | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisière, AP-HP, Paris, France
| | - Rémy Nizard
- Service de Chirurgie Orthopédique, Hôpital Lariboisière, AP-HP, Paris, France
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Petrover D, Richette P. Treatment of carpal tunnel syndrome : from ultrasonography to ultrasound guided carpal tunnel release. Joint Bone Spine 2018; 85:545-552. [DOI: 10.1016/j.jbspin.2017.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 12/17/2022]
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