|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) is a minimally-invasive procedure of performing carpal tunnel release using a piece of surgical dissecting thread as a dividing element.This is instead of using a scalpel as in the situation of open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR).
Under the real-time guidance of ultrasound, a 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 divide the TCL. Once complete, the thread is removed and two small bandages are placed on the needle puncture sites. The procedure takes 10 minutes in a clinic based office.
The frictional effect of a sliding thread can cut tissue. This effect is more moderate than the abrasive effect found when using, for example, a wire saw. The frictional division of soft tissue concentrates the shear 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 allows it to be routed along a designated path to form a loop around the targeted tissue that precisely controls the division. The nature of thread transection 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. Precise looping or routing is essential to the safe and effective use of a dividing thread. Precise routing is achieved percutaneously by use of real-time ultrasound guidance.
The routing control accuracy of TCTR is 0.15-0.20 mm, precise enough to preserve superficial palmar aponeurosis, common digital nerves and the communicating branch between the ulnar nerve and median nerve, while that is difficult or impossible for OCTR or ECTR. Through the technique of TCTR, the possible postoperative complications, such as pillar pain, scar tenderness, or functional weakness, may be minimized significantly by avoiding the unnecessary injuries and disturbers to the surrounding of TCL during the procedure of decompressing the median nerve.
Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, central and peripheral nervous system, and cerebrovascular system.
Carpal tunnel syndrome (CTS) is a medical condition due to compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness and tingling in the thumb, index finger, middle finger and the thumb side of the ring finger. Symptoms typically start gradually and during the night. Pain may extend up the arm. Weak grip strength may occur, and after a long period of time the muscles at the base of the thumb may waste away. In most cases, both hands are affected.
Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.
A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general anesthetic. When it is used on specific nerve pathways, paralysis also can be achieved.
Trigger finger, also known as stenosing tenosynovitis, is a disorder characterized by catching or locking of the involved finger. Pain may occur in the palm of the hand or knuckles. The name is due to the popping sound made by the affected finger when moved. Most commonly the ring finger or thumb is affected.
Interventional radiology (IR) is a medical subspecialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.
Dupuytren's contracture is a condition in which one or more fingers become permanently bent in a flexed position. It usually begins as small, hard nodules just under the skin of the palm, then worsens over time until the fingers can no longer be straightened. While typically not painful, some aching or itching may be present. The ring finger followed by the little and middle fingers are most commonly affected. The condition can interfere with preparing food, writing, and other activities.
Laser ablation or photoablation is the process of removing material from a solid surface by irradiating it with a laser beam. At low laser flux, the material is heated by the absorbed laser energy and evaporates or sublimates. At high laser flux, the material is typically converted to a plasma. Usually, laser ablation refers to removing material with a pulsed laser, but it is possible to ablate material with a continuous wave laser beam if the laser intensity is high enough. Excimer lasers of deep ultra-violet light are mainly used in photoablation; the wavelength of laser used in photoablation is approximately 200 nm.
Pseudocysts are like cysts, but lack epithelial or endothelial cells. Initial management consists of general supportive care. Symptoms and complications caused by pseudocysts require surgery. Computed tomography (CT) scans are used for initial imaging of cysts, and endoscopic ultrasounds are used in differentiating between cysts and pseudocysts. Endoscopic drainage is a popular and effective method of treating pseudocysts.
Radiofrequency ablation (RFA), also called fulguration, is a medical procedure in which part of the electrical conduction system of the heart, tumor or other dysfunctional tissue is ablated using the heat generated from medium frequency alternating current. RFA is generally conducted in the outpatient setting, using either local anesthetics or conscious sedation anesthesia. When it is delivered via catheter, it is called radiofrequency catheter ablation.
Neurolysis is the application of physical or chemical agents to a nerve in order to cause a temporary degeneration of targeted nerve fibers. When the nerve fibers degenerate, it causes an interruption in the transmission of nerve signals. In the medical field, this is most commonly and advantageously used to alleviate pain in cancer patients.
The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.
Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist. Symptoms usually begin with a feeling of pins and needles in the ring and little fingers before progressing to a loss of sensation and/or impaired motor function of the intrinsic muscles of the hand which are innervated by the ulnar nerve. Ulnar tunnel syndrome is commonly seen in regular cyclists due to prolonged pressure of the Guyon's canal against bicycle handlebars. Another very common cause of sensory loss in the ring and pink finger is due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome.
In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand.
Migraine surgery is a surgical operation undertaken with the goal of reducing or preventing migraines. Migraine surgery most often refers to surgical decompression of one or several nerves in the head and neck which have been shown to trigger migraine symptoms in many migraine sufferers. Following the development of nerve decompression techniques for the relief of migraine pain in the year 2000, these procedures have been extensively studied and shown to be effective in appropriate candidates. The nerves that are most often addressed in migraine surgery are found outside of the skull, in the face and neck, and include the supra-orbital and supra-trochlear nerves in the forehead, the zygomaticotemporal nerve and auriculotemporal nerves in the temple region, and the greater occipital, lesser occipital, and third occipital nerves in the back of the neck. Nerve impingement in the nasal cavity has additionally been shown to be a trigger of migraine symptoms.
Endoscopic Carpal Tunnel Release (ECTR) refers to a method of performing carpal tunnel surgery using an endoscope or an arthroscopic device to provide visualization of the anatomic structures.
The Tessys method is a minimally-invasive, endoscopic spinal procedure for the treatment of a herniated disc. It was a further development of the YESS method by the Dutch Dr Thomas Hoogland in the Alpha Klinik in Munich in 1989 and was first called THESSYS. The procedure involves performing a small foramenotomy and removal of soft tissue compressing the nerve root.
Minimally invasive spine surgery, also known as MISS, has no specific meaning or definition. It implies a lack of severe surgical invasion. The older style of open-spine surgery for a relatively small disc problem used to require a 5-6 inch incision and a month in the hospital. MISS techniques utilize more modern technology, advanced imaging techniques and special medical equipment to reduce tissue trauma, bleeding, radiation exposure, infection risk, and decreased hospital stays by minimizing the size of the incision. Modern endoscopic procedures can be done through a 2 to 5 mm skin opening. By contrast, procedures done with a microscope require skin openings of approximately one inch, or more.
Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a surgery in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment. Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.
Thread trigger finger release is an ultrasound guided minimally invasive procedure of performing trigger finger release using a piece of surgical dissecting thread as a dividing element, instead of using a scalpel or a needle tip as in the situation of open trigger finger release or percutaneous trigger finger release.