Thread carpal tunnel release

Under the guidance of ultrasound, the routing needle makes a loop with a piece of cutting thread about the transverse carpal ligament in two needle passes.

Thread Carpal Tunnel Release (TCTR) refers to a minimally invasive procedure of performing carpal tunnel release using a piece of surgical dissecting thread as a dividing element,^[1] instead of using a scalpel as in the situation of open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR).

Thread as a Dividing Tool

Many people intuitively realize that the frictional effect of a sliding thread can cause a finger cut. This effect is more moderate than the abrasive effect found when using, for example, a wire saw. The frictional dividing of soft tissue concentrates shearing forces into the targeted tissue, resulting in significantly less collateral damage to adjacent anatomic structures than can be caused by the plowing and cutting of abrasive dividing.

Thread can be used to divide soft tissue in minimally invasive surgeries due to its unique properties: The flexibility of thread enables it to be routed accurately along a designated path to form a loop around the targeted tissue to precisely control the division.The nature of thread transecting ensures that tissue is divided only inside the loop of thread around the targeted tissue without injuring adjacent non-targeted tissues. Thread can be easily placed using a spinal needle with only two punctures as entry and exit for the thread.

For safe and effective use of a dividing thread, the precision of the looping or routing process is essential. Precise routing is achieved by utilizing the real-time guidance of ultrasound.

Procedure

Procedure of TCTR

Under the real-time guidance of ultrasound, a 18G spinal needle is inserted at the palm of the hand and advanced underneath the transverse carpal ligament (TCL) and exiting at the wrist. Through this needle, a fine smooth thread (0.2 mm in diameter) is fed. The needle is inserted again in the same fashion over the TCL and the thread is again looped through back out of the original needle entry. The thread surrounds the TCL and is manipulated in a back and forth motion to dividing the TCL. Once complete, the thread is moved and two small bandages are placed on the needle placement sites. The procedure takes 15 to 20 minutes in a clinic based office.

Advantage of TCTR

The process control accuracy of the TCTR is precise enough to preserve superficial palmar aponeurosis , common digital nerves and the communicating branch between the ulnar nerve and median nerve, while it is difficult or impossible for OCTR or ECTR. Through the technique of TCTR, all the possible postoperative complications, such as pillar pain, scar tenderness, or functional weakness, might be minimized significantly by avoiding the unnecessary injuries and disturbers to the surrounding of TCL during the procedure of decompressing the median nerve.

Reference

1. Guo, Danqing; Tang, Yu; Ji, Yizheng; Sun, Tiansheng; Guo, Joseph; Guo, Danzhu (2014-06-06). "A non-scalpel technique for minimally invasive surgery: percutaneously looped thread transection of the transverse carpal ligament". HAND 10 (1): 40–48. doi:10.1007/s11552-014-9656-4. ISSN 1558-9447. PMC 4349829. PMID 25767420.