A Clinical Study of the Modified Thread Carpal Tunnel Release

Overview

Journal Hand (N Y)

Publisher Sage Publications

Specialties General Surgery
Orthopedics

Date 2017 Aug 24

PMID 28832215

Citations 22

Authors

Danqing Guo

Danzhu Guo

Joseph Guo

Steven C Schmidt

Rachel M Lytie

Affiliations

Soon will be listed here.

Abstract

Background: Previous studies have indicated that the thread carpal tunnel release (TCTR) is a safe and effective technique. Through a study on 11 cadaveric wrists, the TCTR procedure was modified and the needle control accuracy was improved to 0.15 to 0.2 mm, which is precise enough to preserve superficial palmar aponeurosis (SupPA), Berrettini branch, and common digital nerves. The aim of the present study was to verify the modified TCTR clinically.

Methods: The modified TCTR was performed on 159 hands of 116 patients. The Boston Carpal Tunnel Syndrome Questionnaire was used for assessing the outcomes. Statistical analyses were used to compare the outcomes with the available data from the literature for the open and endoscopic techniques.

Results: TCTR led to significant improvement in the short-term results, and the outcomes were better in long-term results compared with the open or endoscopic release. The SupPA, Berrettini branch, and common digital nerves were protected. There was no neurovascular complication for any case. Significant relief of symptoms was observed 3 to 5 hours post procedure. Most patients used their hands on the day of the procedure for simple daily activity. Patients reported their sleep quality was improved on the surgical day. Most patients with office jobs were able to return to work on postoperative day 1, and those with repetitive jobs returned to work in about 2 weeks. The statistical evidence proves that the modified TCTR procedure results in improved clinical outcomes as compared with open carpal tunnel release (CTR) and endoscopic CTR.

Conclusions: The TCTR procedure has been shown to be a safe and effective technique for CTR. The modified TCTR procedure minimizes postoperative complications, such as pillar pain, scar tenderness, or functional weakness, by avoiding unnecessary injuries to the surrounding structures around the transverse carpal ligament during the procedure.

Citing Articles

Minimally invasive ultrasound-guided thread carpal tunnel release: a video demonstration protocol.

Ferreira-Silva N, Ribeiro-Da-Silva T, Lucas-Neto L, Aziz K, Troyer W, Rosario-Concepcion R J Ultrasound. 2025; .

PMID: 40048109 DOI: 10.1007/s40477-025-01003-0.

Antiplatelet and Anticoagulation Usage During Ultrasound-Guided Incisionless Thread Carpal Tunnel Release.

Dean K, Smith B, Shin A, Brault J Hand (N Y). 2025; :15589447251317237.

PMID: 39976134 PMC: 11843562. DOI: 10.1177/15589447251317237.

Ultrasound-guided minimally invasive thread release of carpal tunnel: a cadaveric study.

Jengojan S, Sorgo P, Piacentini A, Streicher J, Albano D, Kasprian G Radiol Med. 2025; .

PMID: 39836344 DOI: 10.1007/s11547-025-01952-w.

Clinical-applied anatomy of the carpal tunnel regarding mini-invasive carpal tunnel release.

Kaiser P, Schmidle G, Bode S, Seeher U, Honis H, Moriggl B Arch Orthop Trauma Surg. 2024; 144(11):4753-4765.

PMID: 39414675 PMC: 11582268. DOI: 10.1007/s00402-024-05560-7.

Advances in Ultrasound-Guided Surgery and Artificial Intelligence Applications in Musculoskeletal Diseases.

Hattori S, Saggar R, Heidinger E, Qi A, Mullen J, Fee B Diagnostics (Basel). 2024; 14(18).

PMID: 39335687 PMC: 11431371. DOI: 10.3390/diagnostics14182008.

References

Meals R, Shaner M . Variations in digital sensory patterns: a study of the ulnar nerve-median nerve palmar communicating branch. J Hand Surg Am. 1983; 8(4):411-4. DOI: 10.1016/s0363-5023(83)80200-7. View

Ozdogmus O, Cavdar S . Unusual anatomic variation of palmar sensory branches of the ulnar nerve: a case report. J Hand Surg Am. 2002; 27(1):147-9. DOI: 10.1053/jhsu.2002.30368. View

Rojo-Manaute J, Capa-Grasa A, Rodriguez-Maruri G, Moran L, Villanueva Martinez M, Vaquero Martin J . Ultra-minimally invasive sonographically guided carpal tunnel release: anatomic study of a new technique. J Ultrasound Med. 2012; 32(1):131-42. DOI: 10.7863/jum.2013.32.1.131. View

Trumble T, Diao E, Abrams R . Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial. J Bone Joint Surg Am. 2002; 84(7):1107-15. DOI: 10.2106/00004623-200207000-00003. View

Mirza M, King Jr E, Tanveer S . Palmar uniportal extrabursal endoscopic carpal tunnel release. Arthroscopy. 1995; 11(1):82-90. DOI: 10.1016/0749-8063(95)90093-4. View

Gellman H, Botte M, Shankwiler J, Gelberman R . Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res. 2001; (383):41-6. DOI: 10.1097/00003086-200102000-00007. View

Bonnel F, Vila R . Anatomical study of the ulnar nerve in the hand. J Hand Surg Br. 1985; 10(2):165-8. DOI: 10.1016/0266-7681(85)90007-5. View

Ferrari G, Gilbert A . The superficial anastomosis on the palm of the hand between the ulnar and median nerves. J Hand Surg Br. 1991; 16(5):511-4. DOI: 10.1016/0266-7681(91)90105-w. View

Oertel J, Schroeder H, Gaab M . Dual-portal endoscopic release of the transverse ligament in carpal tunnel syndrome: results of 411 procedures with special reference to technique, efficacy, and complications. Neurosurgery. 2006; 59(2):333-40. DOI: 10.1227/01.NEU.0000223500.25131.99. View

10.

Hong J, Lee S, Han S, Son B, Sung J, Park C . Anatomy of neurovascular structures around the carpal tunnel during dynamic wrist motion for endoscopic carpal tunnel release. Neurosurgery. 2006; 58(1 Suppl):ONS127-33. DOI: 10.1227/01.NEU.0000193883.02372.3E. View

11.

Olave E, Del Sol M, Gabriellp C, Mandiola E, Rodrigues C . Biometric study of the relationships between palmar neurovascular structures, the flexor retinaculum and the distal wrist crease. J Anat. 2001; 198(Pt 6):737-41. PMC: 1468262. DOI: 10.1046/j.1469-7580.2001.19860737.x. View

12.

Don Griot J, van Kooten E, Zuidam J, Prose L, Hage J . Internal anatomy of the communicating branch between the ulnar and median nerves in the hand and its relevance to volar digital sensibility. J Hand Surg Am. 2002; 27(1):143-6. DOI: 10.1053/jhsu.2002.30075. View

13.

Agee J, Peimer C, Pyrek J, WALSH W . Endoscopic carpal tunnel release: a prospective study of complications and surgical experience. J Hand Surg Am. 1995; 20(2):165-71; discussion 172. DOI: 10.1016/S0363-5023(05)80001-2. View

14.

Ludlow K, Merla J, Cox J, Hurst L . Pillar pain as a postoperative complication of carpal tunnel release: a review of the literature. J Hand Ther. 1997; 10(4):277-82. DOI: 10.1016/s0894-1130(97)80042-7. View

15.

Dumontier C, Sokolow C, Leclercq C, Chauvin P . Early results of conventional versus two-portal endoscopic carpal tunnel release. A prospective study. J Hand Surg Br. 1995; 20(5):658-62. DOI: 10.1016/s0266-7681(05)80130-5. View

16.

Morrell N, Harris A, Skjong C, Akelman E . Carpal tunnel release: do we understand the biomechanical consequences?. J Wrist Surg. 2014; 3(4):235-8. PMC: 4208956. DOI: 10.1055/s-0034-1394363. View

17.

Guo D, Guo D, Guo J, Malone D, Wei N, McCool L . A Cadaveric Study for the Improvement of Thread Carpal Tunnel Release. J Hand Surg Am. 2016; 41(10):e351-e357. DOI: 10.1016/j.jhsa.2016.07.098. View

18.

Levine D, Simmons B, Koris M, Daltroy L, Hohl G, Fossel A . A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993; 75(11):1585-92. DOI: 10.2106/00004623-199311000-00002. View

19.

Bande S, De Smet L, Fabry G . The results of carpal tunnel release: open versus endoscopic technique. J Hand Surg Br. 1994; 19(1):14-7. DOI: 10.1016/0266-7681(94)90039-6. View

20.

Wilson J . Profiles of the carpal canal. J Bone Joint Surg Am. 1954; 36-A(1):127-32. View