Ultrasound-Guided Fenestration of the Carpal Ligament Using a Double-Needle Approach

Area of Science:

• Interventional Pain Management
• Musculoskeletal Ultrasound
• Peripheral Nerve Procedures

Background:

• Carpal tunnel syndrome (CTS) treatment has advanced from palpation-guided injections to ultrasound-guided techniques.
• Traditional single-needle approaches for carpal tunnel interventions can present technical difficulties.

Observation:

• A case report details a serendipitous discovery during carpal ligament fenestration in a patient with CTS.
• Initial median nerve hydrodissection provided temporary relief, but symptoms recurred.

Findings:

• A novel two-needle technique combining hydrodissection and fenestration was successfully employed.
• The second needle, placed transversely, facilitated hydrodissection and maintained safe separation between the median nerve and carpal ligament.
• The patient experienced 70% symptom relief at 2 weeks and 50% sustained relief at 3 months.

Implications:

• This dual-needle approach is a feasible alternative for complex carpal tunnel cases.
• It enhances safety and efficacy in median nerve hydrodissection and carpal ligament fenestration.
• This technique may overcome limitations encountered with single-needle interventions.