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Sun J, Zou X, Fu Q, Wu J, Yuan S, Alhaskawi A, Dong Y, Zhou H, Abdalbary SA, Lu H. Case report: Ultrasound-guided needle knife technique for carpal ligament release in carpal tunnel syndrome treatment. Front Neurol 2023; 14:1291702. [PMID: 38020668 PMCID: PMC10665483 DOI: 10.3389/fneur.2023.1291702] [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] [Received: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral neuropathy of the hand, mainly manifesting as sensory disturbances, motor dysfunctions, and pain in the fingers and hand. The pathogenesis of the disease is associated with fibrosis of the transverse carpal ligament in the carpal tunnel, which compresses median nerve. In our case, we demonstrate an ultrasound-guided needle knife technique to treat CTS. We guided the patient to a supine position on the examination table. The skin of the wrist area was sterilized for the procedure. After the skin was dry, we positioned sterile drapes, located the median nerve and compression, and marked the compression point. Local anesthesia was administered. An ultrasound-guided needle knife was inserted. The needle knife was advanced under ultrasound guidance. The carpal ligament was incised. A gradual release of pressure on the median nerve was observed on the ultrasound monitor. After treatment, the patient's finger sensation and motor function can significantly improve, and pain symptoms are markedly reduced, this case demonstrates that small needle-knife treatment can serve as a safe and effective minimally invasive therapeutic method.
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Affiliation(s)
- Jianjun Sun
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Xiaodi Zou
- Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinyun Fu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Jianhua Wu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Shuaishuai Yuan
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Ahmad Alhaskawi
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Hui Lu
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Lappen S, Siebenlist S. [Arthroscopic debridement of the extensor carpi radialis brevis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:387-393. [PMID: 37059831 DOI: 10.1007/s00132-023-04373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/16/2023]
Abstract
Surgical treatment of lateral epicondylitis is reserved for patients who, despite extensive conservative therapy, do not experience satisfactory relief of symptoms. As an alternative to the open procedure, arthroscopic debridement of the extensor carpi radialis brevis (ECRB) muscle is a simple and standardized procedure. The arthroscopic approach also enables the additional treatment of intra-articular pathologies such as loose bodies or osteochondral lesions. After diagnostic arthroscopy, the attachment of the ECRB is visualized via the anteromedial portal, so that under visual control the debridement of the tendon fibers of the ECRB and its bony insertion site can be performed via the anterolateral portal. Postoperatively, there is no restriction of movement of the elbow joint. The outcome after arthroscopic ECRB debridement described in the literature is equivalent to that of other surgical techniques.
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Affiliation(s)
- Sebastian Lappen
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Sebastian Siebenlist
- Sektion Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Ge X, Ge X, Wang C, Liu Q, Wang B, Chen L, Cheng K, Qin M. Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study. BMC Musculoskelet Disord 2022; 23:1126. [PMID: 36566206 PMCID: PMC9789568 DOI: 10.1186/s12891-022-06109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/21/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A safe and effective technique for anterolateral portal placement in elbow arthroscopy is significant. We compared the outcomes of patients who underwent elbow arthroscopy using different ultrasound-assisted techniques. METHODS From May 2016 to June 2021 a retrospective analysis on all patients who underwent elbow arthroscopy in our department was performed. Patients were separated into three groups: non-ultrasound; preoperative ultrasound; and intraoperative ultrasound. The minimum follow-up period was 1 year. Nerve injuries, visual analog scale (VAS), Mayo elbow-performance score (MEPS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and range of motion (ROM) of the elbow were evaluated for comparison among the three groups pre- and post-operatively. RESULTS All 55 patients completed a 1-year follow-up: non-ultrasound (n = 20); preoperative ultrasound (n = 17); and intraoperative ultrasound (n = 18). There were 3 cases (15.0%) of transient radial nerve palsy in the non-ultrasound group. No nerve complications occurred in preoperative ultrasound and intraoperative ultrasound groups. The probability of postoperative radial nerve injury in the three groups was statistically different (P < 0.05). There was no significant difference in the VAS score, MEPS, DASH score, and ROM among the three groups at the follow-up evaluation (P > 0.05). CONCLUSION Performing anterolateral portal placement during elbow arthroscopy with ultrasound-assisted techniques successfully avoided radial nerve injury.
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Affiliation(s)
- Xingtao Ge
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Xinghua Ge
- grid.452710.5Department of Neurosurgery, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Chen Wang
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Qinghua Liu
- grid.452710.5Department of Ultrasonography, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Bin Wang
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Longgang Chen
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Kai Cheng
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
| | - Ming Qin
- grid.452710.5Department of Orthopedics, Rizhao People’s Hospital, 276800 Rizhao, Shandong P.R. China
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Niempoog S, Witoonchart K, Jaroenporn W. Hand Surgery in Thailand. J Hand Microsurg 2021; 13:35-41. [PMID: 33707921 DOI: 10.1055/s-0040-1721900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Modern hand surgery in Thailand started after the end of World War II. It is divided into 4 phases. In the initial phase (1950-1965), the surgery of the hand was mainly performed by general surgeons. In 1965-1975, which was the second phase, many plastic surgeons and orthopaedic surgeons graduated from foreign countries and came back to Thailand. They played a vital role in the treatment of the surgery of the hand and set up hand units in many centers. They also contributed to the establishment of the "Thai Society for Surgery of the Hand," which still continues to operate. In the third phase (1975-2000), there was a dramatic development of microsurgery because of the rapid economic expansion. There were many replantation, free tissue transfers, and brachial plexus surgeries in traffic and factory-related accidents. The first hand-fellow training program began in 1993. In the fourth phase (since 2000), the number of hand injuries from factory-related accidents began declining. But the injury from traffic accidents had been increasing both in severity and number. Moreover, the diseases of hand that relate to aging and degeneration had been on the rise. Thai hand surgeons have been using several state-of-the-art technologies such as arthroscopic and endoscopic surgery. They are continuing to invent innovations, generating international publications, and frequently being invited as speakers in foreign countries.
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Affiliation(s)
- Sunyarn Niempoog
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Dai J, Zhang G, Li S, Xu J, Lu J. Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems. Orthop Surg 2020; 12:1464-1470. [PMID: 33015918 PMCID: PMC7670133 DOI: 10.1111/os.12787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems. METHODS A retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery-related complications were assessed. RESULTS Patients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean follow-up time of 10.1 months. The postoperative elbow ROM was 123.2° ± 19°, which was significantly different compared to the preoperative value of 68° ± 32°. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow-up, a mean improvement of 22.5 (range, 0-55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow. CONCLUSION With full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.
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Affiliation(s)
- Junxi Dai
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Guofeng Zhang
- Department of Hand Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Shulin Li
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Jianguang Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiuzhou Lu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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