Ultrasound-guided release of the fibro-osseous tunnels around the wrist and hand: A technical review

Fibro-osseous tunnels allow the unhindered passage of the neurovascular bundle and sliding tendons across the mobile joint. Release of the fibro-osseous tunnels is performed for entrapment neuropathy and stenosing tenosynovitis which occur as a result of increase in the volume/pressure within these tunnels. The common surgical principle in all these pathologies is releasing the pressure by transecting the fascial covering. Primarily these pathologies are treated with open surgery but are potentially amenable to curative percutaneous ultrasound (US) guided release procedures. US is the preferable guiding modality due to its high resolution and real-time demonstration of the anatomy and needle positioning. The advantages of these minimally invasive techniques are lower risk of wound breakdown, quicker healing, reduced post-procedural pain, reduced complications, and a quicker return to normal activity. The release of the tunnel may be achieved by sectioning the thickened pulley or retinaculum with the aid of the needle bevel or surgical-grade thread which are universally available, economical, and equally effective. This article reviews the literature, our institutional experience and the rationale of US-guided percutaneous release procedures in wrist and hand including thread and partial needle carpal tunnel release for carpal tunnel syndrome, needle release for trigger finger, partial needle release for de Quervain’s tenosynovitis and needle aponeurotomy for Dupuytren’s contracture.