Ultrasound-assisted Surgery

Po-Ting Wu^1,2,3,4, I-Ming Jou^5,6,7

¹ Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan
² Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
³ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
⁴ Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
⁵ Department of Orthopaedics, E-Da Hospital, Kaohsiung, Taiwan
⁶ School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
⁷ GEG Orthopedic Clinic, Tainan, Taiwan

Abstract

Carpal tunnel syndrome and De Quervain’s disease are both common disorder around wrist, and surgical release usually leads to satisfactory outcomes. Ultrasound provides a fast, reliable, and radiation-free imaging modality that allows excellent visualization of the wrist anatomical structures. It’s well known that sonography guidance facilitates injection procedures with more and more meta-analysis studies confirming the advantage of sonography guidance. Carpal tunnel release (CTR) is an effective procedure performed in open, endoscopic, or ultrasound-guided methods. Complications are rare, but they can be present and potentially devastating. The majority of complications come from intraoperative technique errors, especially in the minimal invasive approach. Percutaneous carpal tunnel release is increasingly popular, and therefore, understanding the “safe zones” is essential for safely performing percutaneous CTR. This presentation reviews the anatomy of the safe zone and the techniques of ultrasound-guided CTR (UCTR) to prevent the intra-operative complications. Sometimes, anatomical variations such as the ulnar neurovascular bundle being positioned radially to the hamate hook and anomalous collateral vessels existing within the defined safe zones can occur. Using the hydrodissection technique, the safety of the safe zones might be regained in cases with anatomical variations. In strict accordance with the concepts of safe zones, UCTR is an effective and reliable procedure. Ultrasound-guided release for De Quervain’s disease has been reported as a safe and reliable procedure without specific morbidity. Great care should be taken to avoid sensory nerve injuries and to accurately identify the type of sub-compartmentalization with a precise ultrasound evaluation. Additionally, real-time ultrasound also facilitates assessment in fracture reduction and implant protrusion for wrist and elbow fracture osteosynthesis. Substantial experience in ultrasound-guided injection and open surgery are required for ultrasound-assisted surgery.