[Translated article] Percutaneous ultrasound-guided section of the transverse carpal ligament vs. open surgery for the surgical treatment of carpal tunnel syndrome (CTS)

• Published in: Revista española de cirugía ortopédica y traumatología 2023-07, Vol.67 (4), p.T297-T308
• Main Authors: Castro-Menéndez, M., Balvís-Balvís, P., Oiartzabal-Alberdi, I., Ferradás-García, L., González-Rodríguez, E., Yañez-Calvo, J.
• Format: Article
• Language: English
• Subjects: Carpal tunnel syndrome; Cirugía ecoguiada; Cirugía percutánea; Percutaneous surgery; Síndrome del túnel del carpo; Ultrasound-guided surgery
• ISSN: 1888-4415; 1988-8856
• DOI: 10.1016/j.recot.2023.02.023

The gold standard of carpal tunnel syndrome (CTS) treatment is the section of the transverse carpal ligament, the most common technique being the palmar cutaneous incision. Percutaneous techniques have been developed, although their risk/benefit ratio remains controversial. To analyse the functional outcome of patients undergoing CTS percutaneously ultrasound-guided and compare it with those of open surgery. Prospective observational cohort study of 50 patients undergoing CTS (25 percutaneous with WALANT technique and 25 by open surgery with local anaesthesia and tourniquet). Open surgery was performed using a short palmar incision. The percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). A preoperative and postoperative assessment was performed at 2 weeks, 6 weeks and 3 months. Demographic data, presence of complications, grip strength and Levine test score (BCTQ) were collected. The sample consists of 14 men and 36 women with a mean age of 51.4 years (95% CI: 48.4–54.5). Percutaneous technique was performed anterograde using the Kemis H3® scalpel (Newclip). All patients improved from their CTS clinic without obtaining statistically significant differences in BCTQ score, nor in the presence of complications (p>0.05). Patients operated on percutaneously recovered faster grip strength at 6 weeks, but it was similar in the final review. In view of the results obtained, percutaneous ultrasound-guided surgery is a good alternative for the surgical treatment of CTS. Logically, this technique requires its learning curve and familiarisation with the ultrasound visualisation of the anatomical structures to be treated. El gold standard del tratamiento del síndrome del túnel carpiano (STC) es la sección del ligamento transverso del carpo, cuya técnica más común es la incisión cutánea palmar. Se han desarrollados técnicas percutáneas, aunque su relación riesgo/beneficio sigue siendo controvertida. Analizar el resultado funcional de los pacientes intervenidos de STC de forma percutánea ecoguiada y compararlo con el de la cirugía abierta. Estudio de cohortes observacional prospectivo de 50 pacientes intervenidos de STC (25 percutáneos con técnica Walant y 25 por cirugía abierta con anestesia local y manguito de isquemia). La cirugía abierta se efectuó mediante una incisión palmar corta. La técnica percutánea se efectuó de forma anterógrada utilizando el bisturí Kemis® H3 (Newclip). Se realizó una valoración preoperatoria y postoperato