[Ultrasound-guided decompression in the treatment of carpal tunnel syndrome]

Introduction: Carpal-tunnel syndrome is a common disease in Hungary, 1 of 10 people can be affected. The recognition of early symptoms is crucial for the diagnosis and treatment. In severe or conservative treatment resistant cases, surgical decompression could be recommended. Objective: To present a novel ultrasound-guided decompression technique and discuss the clinical results. Method: The surgery is performed in one-day surgery manner and in local anesthesia. Median nerve, crucial vessels and safe zone are determined by ultrasound. The surgical instruments are introduced through a 2-mm skin incision under continuous ultrasound control. The carpal ligament is transected from below with a hook knife to achieve full decompression of the median nerve. Glue is applied for in most cases. Results: The new method was performed in 44 cases between October, 2022 and November, 2023. Preoperatively, every patient underwent an ultrasound examination to exclude secondary causes of carpal tunnel syndrome and contraindications of the technique (for example aberrant vessels). Surgical indications were moderate or severe nerve damage on electrophysiological examination or quality-of-life worsening constant symptoms. Intraoperative or major complications were not detected. Minor complications (skin redness, longer rehabilitation because of early hand constrain) were detected in 2 cases. The patients experienced quick resolution of symptoms from the second postoperative day and used their hands in everyday activity after the surgery. The timeframe of the resolution of numbness was 2,5 weeks on an average. Conclusion: The ultrasound-guided carpal tunnel decompression is an excellent and safe alternative to conventional surgery. The main advantages include small incision, less scarring and faster rehabilitation and return to work. Orv Hetil. 2024; 165(9): 346–350.