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).

Procedure

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.

Thread

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 A wire saw is a saw that uses a metal wire or cable for mechanical cutting of bulk solid material such as stone, wood, glass, ferrites, concrete, metals, crystals etc.. Industrial wire saws are usually powered. There are also hand-powered surv ...

. 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

transect A transect is a path along which one counts and records occurrences of the objects of study (e.g. plants). There are several types of transect. Some are more effective than others. It requires an observer to move along a fixed path and to count ...

ion 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

percutaneous {{More citations needed, date=January 2021 In surgery, a percutaneous procedurei.e. Granger et al., 2012 is any medical procedure or method where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using ...

ly by use of real-time

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

guidance.

Advantage

The routing control accuracy of TCTR is 0.15-0.20 mm, precise enough to preserve superficial

palmar aponeurosis The palmar aponeurosis (palmar fascia) invests the muscles of the palm, and consists of central, lateral, and medial portions. Structure The central portion occupies the middle of the palm, is triangular in shape, and of great strength Its apex ...

, common digital nerves and the communicating branch between the ulnar nerve and

median nerve The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus. The median nerve originates from the lateral and medial cords of the brachial plexus, and has cont ...

, 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.

References

{{Medicine Surgical procedures and techniques Wrist