Ultrasound-Guided Minimal Invasive Carpal Tunnel Release: An Optimized Algorithm

Current treatments for carpal tunnel syndrome rely on open or endoscopic surgical approaches. While these methods are effective, they carry risks of nerve injury and longer recovery times. Ultrasound-guided techniques offer a safer alternative but require precise procedural algorithms. Prior research has shown that high-resolution imaging can improve surgical accuracy. However, no prior work had resolved the optimal sequence for cannula and hook-knife use in this context. This gap motivated the development of a new algorithm to enhance procedural safety. No established protocol yet integrates hydro-inflation with real-time imaging. The absence of a standardized method for fluid-based space expansion remains a challenge. This uncertainty drove the need for a detailed procedural guide. The lack of a validated approach for minimizing tissue trauma in minimal invasive CTR remains unaddressed.

The aim of this work was to introduce a new ultrasound-guided minimal invasive carpal tunnel release algorithm. The specific problem addressed is the risk of nerve injury during conventional techniques. The motivation stems from the need to reduce complications in hand surgery. The study focused on a safety-optimized procedure using a button tip cannula. The goal was to ensure reliable ligament release while avoiding collateral damage. The authors sought to validate a step-by-step method for this approach. The study aimed to confirm that this technique could reduce postoperative symptoms. The authors also intended to demonstrate the feasibility of real-time imaging confirmation.

The study involved 104 patients with diagnosed carpal tunnel syndrome. Patients underwent high-resolution ultrasound imaging of the median nerve. Exclusion criteria included secondary causes like tumors or tendovaginitis. The proposed algorithm was applied using a button tip cannula. The cannula served as a guiding splint for the hook-knife insertion. It also functioned as a hydro-inflation tool during the procedure. Fluid-based expansion of the working space was used as needed. Postoperative ultrasounds confirmed complete ligament transection in all cases.

All patients experienced successful carpal tunnel release. The transverse carpal ligament was fully transected in every case. Real-time imaging confirmed the procedure's success. Symptoms were markedly reduced immediately after the procedure. No complications were reported during the follow-up period. The hydro-inflation method ensured adequate working space. The button tip cannula provided atraumatic guidance throughout. The algorithm's safety was validated by the absence of adverse events.

The proposed algorithm enhances the safety of ultrasound-guided carpal tunnel release. The use of a button tip cannula reduces procedural risks. Hydro-inflation ensures sufficient working space during the procedure. Real-time imaging confirms successful ligament release. The absence of complications supports the method's reliability. The authors suggest this approach as a viable alternative to conventional techniques. The method's safety profile aligns with the study's primary goal. The findings support the adoption of this algorithm in clinical practice.