Ultrasound-guided percutaneous carpal tunnel release in patients on hemodialysis: early experiences and clinical outcomes
Authors Wang PH, Li CL, Shao CJ, Wu KC, Chern TC, Jou IM
Received 22 February 2019
Accepted for publication 23 April 2019
Published 10 June 2019 Volume 2019:15 Pages 711—717
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Deyun Wang
Ping-Hui Wang,1 Chia-Lung Li,2,3 Chung-Jung Shao,4 Kuo-Chen Wu,5 Tai-Chang Chern,6 I-Ming Jou7,8
1Department of Orthopedics, Chi-Mei Medical Center, Tainan 710, Taiwan; 2Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan; 3Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; 4Department of Orthopedics, Tainan Municipal Hospital, Tainan 709, Taiwan; 5Department of Orthopedics, Kuo General Hospital, Tainan, Taiwan; 6Chern Tai-Chang Orthopedic Clinic, Pingtung 900, Taiwan; 7Department of Orthopedics, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; 8Department of Orthopedics, National Cheng Kung University, Tainan, Taiwan
Purpose: The purpose of the current study was to evaluate the effectiveness of ultrasound-guided percutaneous carpal tunnel release in hemodialysis patients with carpal tunnel syndrome.
Methods: From February 2009 to April 2013, a prospective review of 113 consecutive cases of ultrasound-guided percutaneous carpal tunnel release was carried out in 84 hemodialysis patients. Results were analyzed by clinical subjective scale, two self-administered questionnaires, and functional evaluations at seven time points (1 week and 1, 3, 6, 12, 18, and 24 months).
Results: Satisfactory symptom improvement in patients was 82%, 80%, 86%, 89%, 90%, 91%, and 90% at 1 week and 1, 3, 6, 12, 18, and 24 months postoperatively, respectively. Moderate pain was suffered in 11.5% of patients within 1 week, 8.8% within 1 month, 2.7% within 3 months, and none after 12 months postoperatively. Static two-point discrimination and Semmes–Weinstein monofilament examinations presented significant improvements after 1 week and 1 month postoperatively and with time. Postoperative grip power demonstrated recovery and a significant increase after 3 and 6 months postoperatively. Three-jaw chuck-pinch strength showed significant increase after 1 month postoperatively. There were no operative complications.
Conclusion: Ultrasound-guided percutaneous carpal tunnel release is an effective and safe procedure in hemodialysis patients with carpal tunnel syndrome. The advantages include a less invasive procedure, no tourniquet needed, only limited infiltration anesthesia, minimal soft-tissue exploration, and relatively short operation time. Our data suggest this technique can reliably relieve clinical symptoms, with early restoration of grip and pinch strength.
Keywords: carpal tunnel, hemodialysis, ultrasound, percutaneous release
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