J Korean Soc Surg Hand.  2016 Sep;21(3):105-112. 10.12790/jkssh.2016.21.3.105.

Ultrasonography-Guided Surgery around the Wrist and Hand

• Kang HJ
• Kim SJ

• KMID: 2353814
• DOI: http://doi.org/10.12790/jkssh.2016.21.3.105

Abstract

Ultrasonography is used commonly for diagnosis and treatment in orthopedic field, because of low cost and radiation free imaging. Especially, in hand and wrist, where anatomical structures are located superficially, ultrasonography is very useful. Furthermore, major structures could be seen real-time, increasing safety and accuracy in operation. Therefore, some authors are trying ultrasonography-guided surgery around wrist and hand. This article reviewed the ultrasonography-guided surgery around wrist and hand with its technique, indication, and contraindication.

Keyword

Ultrasonography; Surgery; Wrist; Hand

MeSH Terms

Diagnosis
Hand*
Orthopedics
Ultrasonography
Wrist*

Figure

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  Fig. 1. (A) Surgical instruments for ultrasonography-guided percutaneous A1 pulley release: 24-gauge needle, 18-gauge needle, Haki knife and probe. (B) The anatomical landmarks. The needle and Haki knife were inserted 1 cm distal to the proximal crease of the thumb, and at the basal crease of the fingers.

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  Fig. 2. (A) The transducer was positioned at the center of the metacarpophalangeal (MCP) joint and along the mid-line of the flexor tendon. (B) Longitudinal section of sonogram. (C, D) Haki knife inserted to just proximal of the A1 pulley on top of the midline of flexor tendon. Haki knife was hooked around proximal edge of the A1 pulley and the pulley was sectioned by moving the knife from proximal to distal. (E) When A1 pulley is completely released, there is no resistance when probe was gliding over flexor tendons.

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  Fig. 3. (A) Surgical instruments for ultrasonography-guided percutaneous Carpal tunnel release: probe, Freer elevator, dilator, slotted cannula, trocar, endoscopic cutting devices. (B-D) The anatomical landmarks: superficial palmar arch (SPA), median nerve (M), ulnar artery (UA), transverse carpal ligament (TCL) (arrowheads). (E) Check the course of the median nerve in longitudinal view. FDS, flexor digitorum superficialis.

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  Fig. 4. The safe line is defined as midline between the ulnar margin of the median nerve and the radial margin of the ulnar artery. All instruments must be passed along this line under ultrasonographic monitoring.

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  Fig. 5. (A) Freer elevator or probe passing under surface (B) and over surface (C) of the TCL. Axial view of sonogram, the probe (arrow) is always passed along the safe line. (D) Slotted cannula with trocar was inserted beneath the TCL along safe line. After trocar removal, Cutting device is inserted inside slotted cannula. Release of the TCL was done from proximal to distal edge or reversely. All procedure must be done under ultrasonographic monitoring. (E) The TCL is located between two cutter blade. (F) After the device removal, release was confirmed. TCL, transverse carpal ligament; M, median nerve; UA, ulnar artery.

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