WO2015171785A1 - Procédé et appareil de traitement du stc au moyen d'une libération endoscopique du tunnel carpien - Google Patents

Procédé et appareil de traitement du stc au moyen d'une libération endoscopique du tunnel carpien Download PDF

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Publication number
WO2015171785A1
WO2015171785A1 PCT/US2015/029497 US2015029497W WO2015171785A1 WO 2015171785 A1 WO2015171785 A1 WO 2015171785A1 US 2015029497 W US2015029497 W US 2015029497W WO 2015171785 A1 WO2015171785 A1 WO 2015171785A1
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WIPO (PCT)
Prior art keywords
aperture
cutting blade
probe body
recited
blade
Prior art date
Application number
PCT/US2015/029497
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English (en)
Inventor
John Agee
Jeffrey Woodhouse
Ben Goss
Original Assignee
Agee, John M. And Karen K., Trustees Of The John M. Agee Trust
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Agee, John M. And Karen K., Trustees Of The John M. Agee Trust filed Critical Agee, John M. And Karen K., Trustees Of The John M. Agee Trust
Publication of WO2015171785A1 publication Critical patent/WO2015171785A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A61B17/320036—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes adapted for use within the carpal tunnel

Definitions

  • This description pertains generally to treatment of carpal tunnel syndrome and more particularly to both a method and apparatus for treatment by inserting a surgical instrument with a probe into the carpal tunnel and dividing the flexor retinaculum.
  • Carpal tunnel syndrome is a disease that refers to numerous clinical signs and symptoms resulting from an increase in pressure on the median nerve within the carpal tunnel. The increased pressure often compresses the median nerve, compromising its blood flow, resulting in the pain, numbness, and tingling characteristic of this disease. At present, it is the most widespread occupational health hazard in the industrial world.
  • CTS chronic myelosis
  • Non-operative treatments including splinting, anti- inflammatory medications, and cortisone injections into the carpal tunnel, are often used initially to provide temporary relief of the symptoms.
  • the most effective treatment for CTS is surgical division of the flexor retinaculum (often called transverse carpal ligament). Surgical division of the flexor retinaculum causes the divided edges of the ligament to retract; creating a decrease in pressure within the carpal tunnel and restoring normal blood flow to the median nerve, thereby relieving the signs and symptoms of CTS.
  • various techniques exist for releasing the flexor retinaculum the two most commonly used are referred to as open and endoscopic carpal tunnel release.
  • 7,918,784; 8,523,891 and 8,523,892 describe various surgical instruments that are used for ECTR surgery.
  • Reasons for injury to the median nerve include surgeon inexperience, anatomic anomalies, inappropriate dissection techniques, anesthetic application method, forceful insertion of the endoscopic device into the carpal tunnel, poor visibility resulting from either local anesthesia infiltrate, fogging of the endoscopic lens, or excess synovial fluid, and patient movement.
  • an object of the present description is a surgical method and apparatus that offers the reduced post-operative morbidity advantages associated with ECTR, but reduces the risks that are inherent with current surgical instruments that cut the flexor retinaculum from within the carpal tunnel.
  • the present description includes both a method and apparatus for viewing and dividing the flexor retinaculum using an endoscopic surgical instrument that is inserted into the carpal tunnel, thereby decreasing the pressure within the carpal tunnel that impairs median nerve function.
  • a surgical method includes inserting a probe with a cutting blade of an ECTR device under the flexor retinaculum with a radial surface of the probe positioned adjacent the median nerve in the patient's carpal tunnel. With the probe in position and the endoscope viewing the deep side of the flexor retinaculum through the aperture of the probe, the median nerve is adjacent the radial and/or dorsal side of the probe, safely away from the aperture. This relationship exists just prior to the surgeon elevating the cutting blade through the aperture to initiate cutting of the flexor retinaculum.
  • the patient is under some level of sedation and/or anesthesia, but remains alert enough to move and/or withdraw their hand. With this decreased level of consciousness, if a patient experiences either something uncomfortable or sudden pain, the patient may instinctively pull back their hand.
  • This instinctive withdrawal response that often includes finger flexion, with or without wrist flexion, forearm pronation, and elbow flexion, is similar to that of an older infant's startle reflex response.
  • the increase in pressure that exists within the carpal tunnel provides the driving force to translate the median nerve across the aperture of the probe. Because the aperture of the probe has a direct internal path along its longitudinal length to the ambient pressure inside the operating room, a pressure gradient often exists between the aperture inside the carpal tunnel (higher pressure) and the ambient pressure within the operating room (lower pressure). This pressure gradient causes the tissues within the patient's carpal tunnel, specifically the median nerve, to be forced into the aperture where the cutting blade resides.
  • a probe of the present disclosure that includes one or more design features that minimize the pressure gradient, impedes the tendency of the median nerve to easily translate across the radial side of the aperture of the probe, and positions the elevation arc of the cutting blade in a more ulnar position would reduce the risk of injury to the median nerve.
  • the apparatus includes: (a) a hand piece, with or without a pistol grip; (b) a probe assembly with an aperture, which has a ledge on its radial side that is designed to impede translation of the median nerve ulnarwardly over its radial side and into the aperture through which a cutting blade elevates; (c) a pressure block that separates the higher pressure inside the patient's carpal tunnel from the lower pressure outside of the patient's hand; (d) a cutting blade housed within the probe assembly; (e) a blade operating mechanism for elevating the blade into a cutting position at an angle that is inclined toward the ulnar side of the aperture, advancing the blade through the flexor retinaculum, and returning the blade to its concealed, and therefore safer non-cutting position; and (f) an endoscope for viewing the flexor retinaculum through the aperture.
  • FIG. 1 is a perspective view of an endoscopic surgical instrument for performing ECTR using a cutting blade for elevation in a palmar-ulnar direction and a radial ledge, for use on the right hand of a patient during ECTR.
  • FIG. 2 is an exploded perspective view of the probe of FIG. 1 .
  • FIG. 3 is a perspective view of one embodiment of an endoscopic surgical instrument for performing ECTR using a cutting blade for elevation in a palmar-ulnar direction and a radial ledge, for use on the left hand of a patient during ECTR.
  • FIG. 4A is a transverse cross-sectional view of the probe shown in FIG. 2.
  • FIG. 4B is a transverse cross-sectional view of the probe shown in FIG. 3.
  • FIG. 5 is a longitudinal cross-sectional view of the probe shown in FIG. 2.
  • FIG. 6 is a longitudinal cross-sectional view of the endoscopic
  • FIG. 7 is a perspective view of another embodiment of a probe with a transparent sleeve covering the aperture.
  • FIG. 8 is a perspective view of another embodiment of a probe with a transparent endoscopic viewing window designed into the aperture.
  • FIG. 9 is a longitudinal cross-sectional view of another embodiment of a probe with a pressure seal that conforms to both the endoscope and blade operating mechanism.
  • FIG. 10 is a transparent perspective view of the probe shown in
  • FIG. 1 1 is a perspective view of another embodiment of a probe with a pressure O-ring that conforms to the endoscope.
  • FIG. 12 is a longitudinal cross-sectional view of the probe shown in FIG. 1 1 .
  • FIG. 13A is a longitudinal cross-sectional view of another
  • FIG. 13B is a longitudinal cross-sectional view of the endoscopic surgical instrument of FIG. 13A shown with the blade elevated.
  • FIG. 14 is a perspective view of a finger extension clamp in
  • FIG. 15 is a perspective view of another embodiment of a finger extension clamp in accordance with the systems and methods of the present description. DETAILED DESCRIPTION OF INVENTION
  • FIG. 1 through FIG. 15 the apparatus generally shown in FIG. 1 through FIG. 15. It will be appreciated that the apparatus may vary as to configuration and as to details of the parts, and that the method may vary as to the specific steps and sequence, without departing from basic concepts as disclosed herein.
  • FIG. 1 through FIG. 15 detail methods and apparatus for dividing the flexor retinaculum to treat and relieve the signs and symptoms of CTS.
  • an improved endoscopic surgical instrument is inserted into the patient's carpal tunnel to perform cutting of the flexor retinaculum.
  • the palmar and dorsal directions shown in FIG. 1 through FIG. 15 refer to the standard anatomical directions for the palmar and dorsal surfaces of the hand.
  • the proximal and distal directions shown in FIG. 1 through FIG. 15 refer to the standard anatomical directions for proximal and distal of the upper extremity.
  • the radial and ulnar directions shown in FIG. 1 through FIG. 15 refer to the standard anatomical directions for the radial and ulnar sides of the hand.
  • FIG. 1 and FIG. 2 show one embodiment of an endoscopic surgical instrument 10 according to the description for dividing the flexor
  • the endoscopic surgical instrument 10 comprises a hand piece 12, an endoscope 18, and a blade assembly 20a that includes an elongate probe body 36, a cutting blade 16, and a blade operating mechanism 52 (shown in more detail with reference to FIG. 5).
  • the endoscope 18 preferably comprises a standard size endoscope that is detachably received by the hand piece 12.
  • the source attachment connector 42 on the endoscope 18 is oriented in the palmar direction. This orientation for the light source attachment connector 42 is ideal for avoiding interference with the patient's hand and forearm.
  • a standard video camera attachment connector 40 At the proximal end of the endoscope 18 is a standard video camera attachment connector 40. At the distal end of the endoscope is the viewing lens 54 (shown in FIG. 5) that terminates near the proximal end of aperture 24. Aperture 24 and cutting blade 16 are preferably positioned at distal end 30 of the probe body 36, and biased toward the unlar side 28 of the probe 36.
  • the endoscope 18 may be replaced with an image sensor (not shown) that is mounted near the proximal end of the aperture 24 and connected to an externally mounted digital imaging device (not shown) coupled at connector 40.
  • the blade assembly 20a is preferably sterilizable, single use and is detachably received by the hand piece 12 using a thumbscrew 44.
  • an aperture 24 At the distal end of the probe 36 is an aperture 24 on its palmar side that enables viewing of the deep surface of the flexor retinaculum. Additionally, the aperture 24 permits the cutting blade 16 to elevate beyond the palmar surface 22 of the probe 36 upon operation of the blade elevation trigger 14 by the surgeon. With the blade elevation trigger 14 released, the cutting blade 16 resides safely within the aperture 24 where it cannot cut the surrounding soft tissue structures within the patient's wrist or hand.
  • the palmar surface 22 preferably comprises a flat or planar surface as illustrated in FIG. 1 through FIG. 5. However, it is appreciated that other variations are contemplated.
  • the palmar surface 22 may have a slight concavity or roughened surface for retaining or centering the flexor retinaculum in a set position while performing endoscopic release.
  • the probe 36 is fabricated from a
  • the probe 36 is fabricated from a metallic material.
  • the blade assembly 20a is configured for use on the right hand of a patient.
  • the cutting blade 16 elevates through the aperture 24 at an angle CBA (FIG. 4A) toward the ulnar side 28 with respect to a vertical axis ABE that is both perpendicular to the generally flat palmar surface 22 of the probe 36, and intersects the longitudinal axis E L A of the endoscope 18 (see also FIG. 5).
  • This blade angle CBA is shown in FIG. 4A in a preferred orientation of approximately 20 degrees, but may range from 1 degree to 45 degrees or more. The greater the blade angle CBA, the further the cutting blade 16 is positioned in the ulnar direction, away from the median nerve 48.
  • a similar blade assembly 20b is shown for use on the left hand of a patient.
  • the difference between the blade assembly 20a for a right hand versus the blade assembly 20b for a left hand is that the cross-sectional profile of the probe body 36 is rotated 180 degrees about the vertical axis ABE that is both perpendicular to the flat palmar surface 22 of the probe body 36, and intersects the longitudinal axis E L A of the endoscope 18.
  • the cross-sectional shape of the probe 36 for both blade assemblies 20a and 20b preferably comprises a ledge 26 on the radial side.
  • the asymmetric shape of the probe 36 ensures that the ledge 26 is adjacent to and at least partially cups the patient's median nerve 48, thereby positioning the nerve 48 against the lower surface 38 (which encompasses both dorsal and radial surfaces) of the ledge 26 to at least partially cup the median nerve 48.
  • the ledge 26 acts to relatively retard and/or prevent the median nerve 48 from translating across the palmar surface 22 of the probe body 36 and entering or nearing the aperture 24 where the cutting blade 16 resides.
  • Both the ledge 26 and blade angle CBA provide safety features to prevent the median nerve 48 from being accidentally cut during ECTR surgery.
  • aperture 24 are offset from the radial side (i.e. ledge 26) as a result of the extent blade angle C B A, the extent of extension of the ledge 26 laterally in the radial direction, or preferably a combination of both. It is appreciated that a smaller angle CBA (e.g. 0 degrees) may be used based on a larger offset as a result of extension of ledge 26 in the radial direction.
  • a smaller angle CBA e.g. 0 degrees
  • FIG. 5 shows a longitudinal cross-sectional view of the blade
  • Blade assembly 20a may comprise a proximal coupling 32 to engage with section 62 of endoscope 18.
  • Blade operating mechanism 52 generally comprises a rod that is coupled to the blade at pivot 56, which in cooperation with pin 58, guides the blade 16 through its articulation outward and inward from the aperture 24.
  • Rotation of the blade assembly 20a may also be visually referenced via flap 34 and corresponding collar element 60 of the endoscope 18. As shown in FIG. 6, rotation of the blade assembly 20a may also be keyed to the endoscope via palmar slot 68 and corresponding palmar rib element 60 of the endoscope 18. Rotation of the blade assembly 20a may also be keyed to the endoscope 18 via both dorsal rib element 72 and
  • FIG. 7 shows another embodiment of a blade assembly 80 for use with an endoscopic surgical instrument 10 for dividing the flexor
  • the probe 84 body in this embodiment has a sleeve 82 that is slidably received over the probe 84.
  • the sleeve 82 is a thin, hollow, and optically transparent commercially available heat shrinkable material that is open at its proximal and distal ends, enabling it to slide from distal to proximal over the probe 84.
  • the sleeve 82 may be heated by radiant or convection heating to shrink the sleeve 82 such that it conforms to the shape of the four surfaces of the probe 84 (palmar surface 22, dorsal surface, radial surface 26, and ulnar surface 28).
  • the sleeve 82 may be made of a non-distorting and
  • the slit 86 in the palmar surface of the sleeve 82 exists prior to elevation of the cutting blade 16 so that the cutting blade 16 passes through a pre-cut slit 86.
  • a sleeve 82 prevents fluids inside the carpal tunnel from contacting the viewing lens 54 (FIG. 5) of the endoscope 18 and distorting or obstructing the image of the contents of the carpal tunnel. By separating the dry, cooler air environment surrounding the viewing lens 54 of the endoscope 18 from the moist, warmer environment within the carpal tunnel, the sleeve 82 also reduces the potential for condensation to form on the viewing lens 54, thereby reducing the incidence and/or severity of fogging that often occurs on the viewing lens 54 when performing ECTR surgery.
  • the sleeve 82 also traps the heat generated by the light from the endoscope, causing the air temperature inside the probe 84 to increase, thereby elevating the dew point and further reducing the potential for fogging of the viewing lens 54 with a secondary loss of image resolution from the endoscope 18 during the surgical procedure.
  • FIG. 8 shows another embodiment of a blade assembly 90 for use with an endoscopic surgical instrument 10 for dividing the flexor
  • the probe 94 in this embodiment has a window 92 that is inserted into the aperture 24 (FIG. 2) on the palmar surface 22 of the distal end 98 of the probe 94.
  • the window 92 may be bonded to a shallow ledge (not shown) within the aperture 24, or via other attachment means.
  • the window 92 is preferably made of a non-distorting and optically clear transparent material that allows viewing by the endoscope 18 (FIG. 5) through the window 92.
  • FIG. 9 and FIG. 10 show another embodiment of a blade assembly 100 for use with an endoscopic surgical instrument 10 for dividing the flexor retinaculum.
  • the increased pressure that exists within the carpal tunnel provides the driving force to translate the median nerve across the aperture 24 of the probe 104. Because the aperture 24 of the probe 104 has a direct internal path along its longitudinal length to the ambient pressure inside the operating room, a pressure gradient may exist between the aperture 24 inside the carpal tunnel (higher pressure) and the ambient pressure within the operating room (lower pressure). This pressure gradient may cause the tissues within the patient's carpal tunnel, specifically the median nerve, to be drawn into the aperture 24 where the cutting blade 16 resides.
  • the probe 104 in this embodiment comprises a seal 102 that provides a barrier to separate the higher-pressure environment within the carpal tunnel from the lower-pressure environment within the operating room.
  • the seal 102 may comprise an elastic material that fits within the probe 104 at a location proximal to the aperture 24.
  • the outside dimension (OD) of the seal 102 provides an interference fit with the internal dimension of the longitudinal passageway of the probe 104 where the endoscope 18 and blade operating mechanism 106 traverse from the proximal end to distal end.
  • the seal 102 preferably comprises two longitudinal thru holes to
  • distal end 108 of the probe 104 may comprise a strut 1 10 that guides motion of the blade 16 via pin 1 12 upon
  • FIG. 1 1 and FIG. 12 show an alternative embodiment of a blade assembly 120 for separating the higher-pressure environment within the carpal tunnel from the lower-pressure environment within the operating room.
  • the endoscope 18 passes from proximal to distal through the longitudinal bore of the probe 122 and uses an O-ring seal 126 to provide the barrier around the endoscope 18.
  • the blade operating mechanism 124 is mounted external to the longitudinal bore of the probe 122 and therefore does not require a sealing means, since it does not provide a fluid or air path between the higher-pressure
  • FIG. 13A and FIG. 13B show an alternative embodiment of an
  • the endoscope 18 translates from a proximal position (FIG. 13A) to a distal position (FIG. 13B) when the blade elevation trigger 146 is depressed from distal to proximal by the surgeon.
  • the viewing lens 54 (FIG. 5) of the endoscope 18 is repositioned nearer the cutting blade 16 to provide a magnified image on the video monitor (not shown).
  • a pivot link 148 inserts into a slot 150 in the blade elevation trigger 146.
  • the opposite end of the pivot link 148 inserts into a cylindrical groove 152 in the translator mechanism 154.
  • the pivot link 148 rotates counter-clockwise, moving the translator mechanism 154.
  • the translator mechanism 154 is slidably received on and secured to the longitudinal shaft of the endoscope 18 in a distal direction.
  • the pivot link 148 rotates clockwise, moving the translator mechanism 154 and endoscope 18 in a proximal direction.
  • FIG. 14 shows one embodiment of a finger extension clamp 200. If the patient flexes their fingers while the surgeon is performing endoscopic surgery for CTS, the lumbrical muscles move from distal to proximal, entering the carpal tunnel. Consequently, the pressure within the carpal tunnel increases. If the patient then grips forcefully, the lumbrical muscles contract, causing the pressure within the carpal tunnel to increase significantly more. This increase in pressure acts to create a pressure differential that will translate the median nerve across the margins of the aperture of the endoscopic surgical instrument, increasing the risk of injury to the median nerve if the cutting blade is elevated.
  • the finger extension clamp 200 minimizes the angle of flexion of the patient's fingers at all three joints of each finger (distal interphalangeal joints, proximal interphalangeal joints, and metacarpophalangeal joints), at the time of surgery. This minimizes the pressure differential that can cause the median nerve to translate into the path of the elevating cutting blade and/or the cutting blade's proximal translation during the withdrawal maneuver for division of the flexor retinaculum.
  • the finger extension clamp 200 is a preferred embodiment, the finger extension clamp 200
  • a plastic sheet material that easily conforms to the dorsal side of the patient's forearm, wrist, and hand.
  • a strap 202 that secures the finger extension clamp 200 to the patient's forearm, proximal to their wrist.
  • a U-shaped bend 206 that forms the palmar clamp 204, which secures the patients fingers and limits them from flexing.
  • FIG. 15 shows another embodiment of a finger extension clamp 250.
  • the finger extension clamp minimizes the patient's fingers from flexing at their distal and proximal interphalangeal joints, leaving the metacarpophalangeal (MCP) joints free to flex.
  • the finger extension clamp 250 comprises a rigid outer layer 252 made from a polymeric (e.g. plastic) sheet material (or similar suitable rigid material) and an inner layer 254 made from a compliant foam, rubber or like material.
  • the inner layer 254 aids in distributing the clamping force over all the fingers and provides the friction needed to prevent the finger extension clamp 250 from sliding off of the fingers.
  • the finger extension clamp 250 is U-shaped and slides over the distal end of the patient's four fingers until the proximal end is just distal to the MCP joints of the fingers.
  • the dorsal and palmar surfaces of the outer layer 252 are preferably substantially parallel.
  • the proximal end of the finger extension clamp 250 opens to conform to the tapered profile of the patient's fingers.
  • the proximal end of the finger extension clamp 250 is preferably tapered from radial to ulnar to conform to the shape of the MCP joints.
  • present disclosure encompasses multiple embodiments which include, but are not limited to, the following:
  • An apparatus for treating a flexor retinaculum for carpal tunnel release surgery within a patient comprising: an elongate probe body comprising a longitudinal axis terminating at a distal end, and a radial surface and palmar surface both extending proximally from the distal end; wherein the elongate probe body is configured to be inserted in a carpal tunnel of the patient such that the radial surface is positioned adjacent a median nerve of the patient; an aperture disposed in the probe body within the palmar surface at a location near the distal end; and a cutting blade disposed within the aperture; wherein the cutting blade is coupled to the probe body such that it is configured to reciprocate from a retracted position within the aperture to an extended position extending outward from the palmar surface; and wherein the cutting blade extends into the extended position in a plane that is offset from the longitudinal axis away from the radial surface toward the ulnar surface.
  • the probe body further comprising a dorsal surface adjacent the radial surface and extending parallel to the longitudinal axis proximally from the distal end; wherein the ledge forms a lower surface that encompasses at least a portion of the dorsal surface and radial surface of the ledge to at least partially cup the median nerve when the probe body is inserted in the carpal tunnel.
  • any preceding embodiment further comprising: an optical system inserted within the probe body along said longitudinal axis; said optical system having a distal portion terminating adjacent a proximal end of the aperture, thereby defining a viewing space between the distal portion of the optical system and a distal end of the aperture; wherein the cutting blade extends from the viewing space through the aperture.
  • aperture is covered with a substantially transparent material.
  • substantially transparent material comprises a sleeve that is shrink-fit to the probe body.
  • substantially transparent material comprises a window that is inserted onto a surface of the aperture.
  • optical system is coupled to the blade operating mechanism such that operation of the blade operating mechanism translates the distal portion of the optical system distally within the aperture when extending the cutting blade.
  • An apparatus for treating a flexor retinaculum for carpal tunnel release surgery within a patient comprising: an elongate probe body comprising a longitudinal axis terminating at a distal end, and a radial surface and palmar surface both extending proximally from the distal end; wherein the elongate probe body is configured to be inserted in a carpal tunnel of the patient such that the radial surface is positioned adjacent a median nerve of the patient; an aperture disposed in the probe body within the palmar surface at a location near the distal end; and a cutting blade disposed within the aperture; wherein the cutting blade is coupled to the probe body such that it is configured to reciprocate from a retracted position within the aperture to an extended position extending outward from the palmar surface; wherein the aperture is covered with a substantially transparent material.
  • substantially transparent material comprises a sleeve that is shrink-fit to the probe body.
  • substantially transparent material comprises a window that is inserted onto a surface of the aperture.
  • An apparatus for treating a flexor retinaculum for carpal tunnel release surgery within a patient comprising: an elongate probe body comprising a longitudinal axis terminating at a distal end, and a radial surface and palmar surface both extending proximally from the distal end; wherein the elongate probe body is configured to be inserted in a carpal tunnel of the patient such that the radial surface is positioned adjacent a median nerve of the patient; an aperture disposed in the probe body within the palmar surface at a location near the distal end; and a cutting blade disposed within the aperture; wherein the cutting blade is coupled to the probe body such that it is configured to reciprocate from a retracted position within the aperture to an extended position extending outward from the palmar surface; a blade operating mechanism coupled to the blade for selectively and incrementally extending and retracting the cutting blade out of and back into the aperture; an optical system inserted within the probe body along said longitudinal axis; said optical system having a
  • proximal end connectable to a surgical hand piece, wherein the proximal end is open so as to allow passage of an optical system and a cutting blade extension system; (b) a distal end, wherein the distal end is closed; and (c)a hollow length extending from the proximal end to the distal end, the hollow length comprising: a flat top surface with a lateral aperture near the distal end through which a cutting blade can be extended and retracted under operation of the cutting blade extension system while visualizing tissue at the lateral aperture with the optical system, wherein the cutting blade extends from the aperture at an angle to a vertical axis that is both perpendicular to the flat top surface of the probe and intersects the longitudinal axis of the optical system, the flat top surface having a width dimension spanning a distance from a radial side to an ulnar side of the flat top surface, wherein the distance from a vertical axis that is both perpendicular to the flat top surface of the probe and intersect
  • the lower surface also having a width dimension which is equal to the width dimension of the flat top surface for a defined distance below the flat top surface, wherein the defined distance is greater than zero inches but less than 0.125 inches.
  • a method for treating a flexor retinaculum for carpal tunnel release surgery within a patient comprising: providing an elongate probe body comprising a longitudinal axis terminating at a distal end, and a radial surface and palmar surface both extending proximally from the distal end; inserting the elongate probe body into in a carpal tunnel of the patient such that the radial surface is positioned adjacent a median nerve of the patient; wherein an aperture disposed in the probe body within the palmar surface at a location near the distal end is positioned adjacent the flexor retinaculum; reciprocating a cutting blade that is coupled to the probe body from a retracted position within the aperture to an extended position extending outward from the palmar surface; wherein the cutting blade extends into the extended position in a plane that is offset from the longitudinal axis away from the radial surface toward the ulnar surface; and cutting at least a portion of the flexor retinaculum with the cutting blade.
  • cutting the flexor retinaculum comprises dividing the flexor retinaculum.
  • the probe body further comprising a dorsal surface adjacent the radial surface and extending proximally from the distal end; wherein the ledge forms a lower surface that encompasses at least a portion of the dorsal surface and radial surface of the ledge; the method further comprising cupping at least a portion of the median nerve with the lower surface when the probe body is inserted in the carpal tunnel.
  • the probe further comprising an optical system inserted within the probe body along said longitudinal axis; said optical system having a distal portion terminating adjacent a proximal end of the aperture, thereby defining a viewing space between the distal portion of the optical system and a distal end of the aperture; the method further comprising viewing the aperture and flexor retinaculum with the optical system while the cutting blade extends from the viewing space through the aperture.
  • the substantially transparent material comprises a sleeve that is shrink-fit to the probe body.
  • MCP metacarpophalangeal
  • the finger extension clamp comprises a u-shaped clamp having a rigid outer layer and a compliant inner layer for distributing the clamping force over all the fingers and providing friction needed to prevent the finger extension clamp from sliding off of the fingers.
  • a finger extension clamp that minimizes the angle of flexion of the patient's fingers at the distal interphalangeal joint, proximal
  • the finger extension clamp comprises a strap that secures the finger extension clamp to a patient's forearm, proximal to the wrist; and a U-shaped bend at the distal end of the finger extension clamp that forms the palmar clamp that secures the patients fingers to limit them from flexing.

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Abstract

La présente invention concerne un appareil et un procédé de réalisation d'une chirurgie de libération endoscopique du tunnel carpien, permettant de réduire la pression à l'intérieur du tunnel carpien qui altère la fonction du nerf médian. Ledit appareil comprend un corps de sonde allongé conçu pour être inséré dans le tunnel carpien, une ouverture pratiquée dans le corps de sonde, et une lame de coupe placée à l'intérieur de l'ouverture, ladite lame de coupe étant conçue pour effectuer un va-et-vient depuis une position rétractée à l'intérieur de l'ouverture jusqu'à une position étendue s'étendant vers l'extérieur depuis une surface palmaire.
PCT/US2015/029497 2014-05-06 2015-05-06 Procédé et appareil de traitement du stc au moyen d'une libération endoscopique du tunnel carpien WO2015171785A1 (fr)

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10806481B2 (en) 2015-10-02 2020-10-20 Nanice Medical Solutions Llc Surgical device for use in endoscopic carpal tunnel release (ECTR), endoscopic cubital tunnel release (ECuTR), and endoscopic plantar fasciitis release (EPFR)
US11033291B2 (en) 2015-10-02 2021-06-15 Nanice Medical Solutions Llc Surgical device for use in endoscopic carpal tunnel release (ECTR), endoscopic cubital tunnel release (ECuTR), and endoscopic plantar fasciitis release (EPFR)

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