Brault, Jeffrey S

Background: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. The thread carpal tunnel release (TCTR) is an incision-less ultrasound-guided approach to divide the transverse carpal ligament. This retrospective case series aims to identify and assess the bleeding risks associated with continuing anticoagulation or antiplatelet therapy during TCTR. Methods: Retrospective chart review with follow-up questionnaires/surveys. One hundred and fourteen adult patients who were using antiplatelet or anticoagulation medication underwent 164 TCTR procedures during 2018 to 2023 at a single institution (tertiary care hospital) from June 29, 2018, and August 11, 2023. A chart review was performed to identify patients on antiplatelets or anticoagulants at the time of the procedure and to determine if there were any adverse events associated with continuing or holding their antiplatelet or anticoagulant therapy. Results: There were no significant complications associated with continuing or holding anticoagulation or antiplatelet therapy during TCTR. Conclusions: Continuing antiplatelet therapy during TCTR appears safe. The decision to continue antiplatelet or anticoagulation therapy should be made on a case-by-case basis.

AbstractIntroductionCarpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Although prior studies have explored the anatomic changes of the median nerve and carpal arch with different wrist deviations and positionings, the change in safe zone distance between the median nerve and ulnar artery with ulnar or radial wrist deviations has not been adequately investigated.ObjectiveTo identify the optimal wrist positioning that increases the safe zone distance between the median nerve and ulnar artery using ultrasound in patients with CTS.DesignRetrospective cohort study.SettingQuaternary medical center multidisciplinary outpatient hand clinic.ParticipantsTwenty five patients (41 wrists) with clinical CTS who received an electrodiagnostic study (EDX) to evaluate CTS within 1 year prior to enrollment.InterventionsUltrasound‐identified safe zone distance measurements were obtained in each patient between the ulnar aspect of the median nerve and the radial aspect of the ulnar artery with the wrist in neutral radial‐ulnar deviation as well as in passive ulnar and radial deviation.Main Outcome MeasureThe ultrasound‐identified safe zone distance with the wrist in each of the three positions.ResultsThe interstructural safe zone distance was significantly greater when measured in the ulnarly deviated position (1.08 cm) compared with either the neutral (0.61cm, p < .001) or radially deviated positions (0.52 cm, p < .001). Interstructural safe zone distance did not differ between those with normal, mild, moderate, or severe classifications of pathology, or between dominant and nondominant limbs.ConclusionThis study demonstrates that the ultrasound‐measured interstructural safe zone distance was significantly greater in the ulnarly deviated position than in either the neutral position or radially deviated position. These findings may lead to improvement in the safety of ultrasound‐guided injections.