Effect of needle-knife release on the median nerve and transverse carpal ligament in rabbits with carpal tunnel syndrome

doi:10.12122/j.issn.1673-4254.2025.11.08

Abstract

Abstract:

Objective To investigate the effect of needle knife release on median nerve (MN) and transverse carpal ligament (TCL) morphology and function and expression levels of inflammatory factors in rabbit models of carpal tunnel syndrome (CTS). Methods Thirty adult New Zealand rabbits were randomized equally into control group, CTS model group, ultrasound-guided needle knife release group, needle knife release group without ultrasound guidance, and sham treatment groups. In all but the control group, the rabbits were subjected to CTS modeling by 10% glucose solution injection into the carpal tunnel once a week for 4 consecutive weeks, followed by interventions with a single treatment session. At 3 days and 30 days after the interventions, 3 rabbits from each group were selected for ultrasound measurement of TCL and MN thickness, electrophysiological testing, ultrasound elastography, and inflammatory cytokine level assessment. Results In the rabbit models of CTS, ultrasound-guided needle knife release significantly reduced the thickness of TCL and MN and improved sensory nerve conduction velocity at both 3 and 30 days after the intervention. Elastography of the TCL showed markedly softened intra-carpal tissues after ultrasound-guided needle knife release and achieved superior outcomes over those in the other groups. The treatment also significantly reduced IL-17 levels and lowered IL-6 and PGE2 expression at 30 days after the intervention. Conclusion Needle knife release of the TCL reduces thickness of the MN and TCL, enhances median nerve function, alleviates intrascatic tissue stiffness, and downregulates inflammatory factors in the carpal tunnel in rabbit models of CTS, and ultrasound guidance further enhances its therapeutic efficacy.

Key words: needle-knife releas, carpal tunnel syndrome, transverse carpal ligament, median nerve, ultrasonic guidance

Yunnan LI, Qiaoyin ZHOU, Shen LUO, Weilin LIN, Xinyao HUANG, Ying CAO. Effect of needle-knife release on the median nerve and transverse carpal ligament in rabbits with carpal tunnel syndrome[J]. Journal of Southern Medical University, 2025, 45(11): 2358-2364.

Figures/Tables 11

References 32

[1]	Osiak K, Elnazir P, Walocha JA, et al. Carpal tunnel syndrome: state-of-the-art review[J]. Folia Morphol (Warsz), 2022, 81(4): 851-62. doi：10.5603/fm.a2021.0121
[2]	Ari B, Akcicek M, Tasci I.et al. Correlations between transverse carpal ligament thickness measured on ultrasound and severity of carpal tunnel syndrome on electromyography and disease duration.[J]. Hand Surg Rehabil, 2022, 41(3): 377-83. doi：10.1016/j.hansur.2022.02.006
[3]	Wallace JL. Prostaglandin biology in inflammatory bowel disease[J]. Gastroenterol Clin North Am, 2001, 30(4): 971-80. doi：10.1016/s0889-8553(05)70223-5
[4]	McLoughlin RM, Hurst SM, Nowell MA.et al. Differential regulation of neutrophil-activating chemokines by IL-6 and its soluble receptor isoforms[J]. J Immunol, 2004, 172(9): 5676-83. doi：10.4049/jimmunol.172.9.5676
[5]	Raucci F, Saviano A, Casillo GM, et al. IL-17-induced inflammation modulates the mPGES-1/PPAR‑γ pathway in monocytes/macro-phages[J]. Br J Pharmacol, 2022, 179(9): 1857-73. doi：10.1111/bph.15413
[6]	周俏吟, 申毅锋, 邱祖云, 等.超声引导针刀松解术在四肢末端病的临床解剖学中的应用研究[J].中国医药导报, 2023, 20(18): 20-4.
[7]	周俏吟.超声引导下针刀松解腕横韧带治疗腕管综合征的作用机制研究[D].福建中医药大学, 2023.
[8]	陈国良, 江大平, 许晓文. 分析腕管综合征患者接受高频超声与肌电图诊断的效果[J].中国医疗器械信息, 2024, 30(16): 129-31.
[9]	Chen YT, Miller Olson EK, Lee SH, et al. Assessing Diagnostic and Severity Grading Accuracy of Ultrasound Measurements for Carpal Tunnel Syndrome Compared to Electrodiagnostics[J]. PMR, 2021,13(8): 852-61. doi：10.1002/pmrj.12533
[10]	Chen J, Fowler JR. Comparison of diagnostic accuracy of electrodiagnostic testing and ultrasonography for carpal tunnel syndrome[J]. Hand (N Y), 2023, 18(3): 407-12. doi：10.1177/15589447211038701
[11]	Lee SK, Hwang SY, An YS, et al. The influence of transverse carpal ligament thickness on treatment decisions for idiopathic mild to moderate carpal tunnel syndrome[J]. Ann Plast Surg, 2020, 85(2): 127-34. doi：10.1097/sap.0000000000002386
[12]	Wu H, Yang K, Chang X, et al. Evaluation of the transverse carpal ligament in carpal tunnel syndrome by shear wave elastography: a non-invasive approach of diagnosis and management[J]. Front Neurol, 2022, 13: 901104. doi：10.3389/fneur.2022.901104
[13]	Ahmed A, Malik G, Imtiaz H, et al. Assessment of carpal tunnel syndrome with ultrasonography[J]. J Ayub Med Coll Abbottabad, 2022, 34(2): 295-9. doi：10.55519/jamc-02-9892
[14]	Freeland AE, Tucci MA, Barbieri RA, et al. Biochemical evaluation of serum and flexor tenosynovium in carpal tunnel syndrome[J]. Microsurgery, 2002, 22(8): 378-85. doi：10.1002/micr.10065
[15]	Tucci MA, Barbieri RA, Freeland AE. Biochemical and histological analysis of the flexor tenosynovium in patients with carpal tunnel syndrome[J]. Biomed Sci Instrum, 1997, 33: 246-51.
[16]	Rempel D, Dahlin L, Lundborg G. Pathophysiology of nerve compression syndromes: Response of peripheral nerves to loading[J]. J Bone Joint Surg Am, 1999, 81(11): 1600-10. doi：10.2106/00004623-199911000-00013
[17]	Robben E, Dusar FR, Weyns V, et al. Ultrasound measurement of subsynovial connective tissue thickness in the carpal tunnel: An intrarater/interrater reliability and agreement study[J]. Hand Surg Rehabil, 2023, 42(6): 505-11. doi：10.1016/j.hansur.2023.08.006
[18]	Nishida K, Yamasaki S, Ito Y, et al.FcεRI-mediated mast cell degranulation requires calcium-independent microtubule-dependent translocation of granules to the plasma membrane[J]. J Cell Biol, 2005, 170(1): 115-26. doi：10.1083/jcb.200501111
[19]	Tsuge K, Inazumi T, Shimamoto A, , et al.Molecular mechanisms underlying prostaglandin E2-exacerbated inflammation and immune diseases[J]. Int Immunol, 2019, 31(9): 597-606. doi：10.1093/intimm/dxz021
[20]	Onishi RM, Gaffen SL. Interleukin-17 and its target genes: mechanisms of interleukin-17 function in disease[J]. Immunology, 2010, 129(3): 311-21. doi：10.1111/j.1365-2567.2009.03240.x
[21]	Fossiez F, Banchereau J, Murray R, et al. Interleukin-17[J]. Int Rev Immunol, 1998, 16(5/6): 541-51. doi：10.3109/08830189809043008
[22]	Murakami M, Naraba H, Tanioka T, et al. Regulation of prostaglandin E2 biosynthesis by inducible membrane-associated prostaglandin E2 synthase that acts in concert with cyclooxygenase-2[J]. J Biol Chem, 2000, 275(42): 32783-92. doi：10.1074/jbc.m003505200
[23]	Akaogi J, Nozaki T, Satoh M, et al. Role of PGE2 and EP receptors in the pathogenesis of rheumatoid arthritis and as a novel therapeutic strategy[J]. Endocr Metab Immune Disord Drug Targets, 2006, 6(4): 383-94. doi：10.2174/187153006779025711
[24]	Genova A, Dix O, Saefan A, et al. Carpal tunnel syndrome: a review of literature[J]. Cureus, 2020, 12(3): e7333.
[25]	段承琪, 郭建明, 陈小波. 轻中度腕管综合征物理治疗的研究进展[J]. 实用手外科杂志, 2025, 39(1): 82-4.
[26]	Malakootian M, Soveizi M, Gholipour A, et al. Pathophysiology, diagnosis, treatment, and genetics of carpal tunnel syndrome: a review[J]. Cell Mol Neurobiol, 2023, 43(5): 1817-31. doi：10.1007/s10571-022-01297-2
[27]	刘子文, 刘文辉, 韩海, 等. 正中神经主干联合返支松解治疗中重度腕管综合征的临床效果[J]. 中国卫生标准管理, 2024, 15(16): 80-4.
[28]	Castro-Menéndez M, Balvís-Balvís P, Oiartzabal-Alberdi I,et al.Percutaneous ultrasound-guided section of the transverse carpal ligament vs open surgery for the surgical treatment of carpal tunnel syndrome (CTS)[J]. Rev Esp Cir Ortop Traumatol, 2023, 67(4): T297-308. doi：10.1016/j.recot.2023.02.023
[29]	Saaiq M. Presentation and outcome of carpal tunnel syndrome with mini incision open carpal tunnel release[J]. Med J Islam Repub Iran, 2021, 35: 67. doi：10.47176/mjiri.35.67
[30]	Jin G Q, Yang J, Li C Y, et al. Treatment of carpal tunnel syndrome with mini-incision decompression[J]. China J Orthop Traumatol, 2012, 25(1): 58-61.
[31]	David I. Sonography-guided carpal tunnel release[J]. Hand Clin, 2022, 38(1): 75-82. doi：10.1016/j.hcl.2021.08.007
[32]	Zhou Q, Shen Y, Zhu X, et al. Ultrasound-guided percutaneous release procedures in the transverse carpal ligament by acupotomy: A cadaveric study[J]. Front Surg, 2023, 9: 906109. doi：10.3389/fsurg.2022.906109

Group	3 days	30 days
Control	0.03±0.017	0.05±0.005^△#
Model	0.05±0.008	0.06±0.011*^#
Ultrasound	0.03±0.006	0.05±0.011^△#
Non-ultrasound	0.04±0.004	0.06±0.006*^#
Sham treatment	0.05±0.007	0.06±0.008*^#
F/KW	12.680	10.083
P	<0.001	<0.001

Group	3 days	30 days
Control	0.03±0.017	0.05±0.005^△#
Model	0.05±0.008	0.06±0.011*^#
Ultrasound	0.03±0.006	0.05±0.011^△#
Non-ultrasound	0.04±0.004	0.06±0.006*^#
Sham treatment	0.05±0.007	0.06±0.008*^#
F/KW	12.680	10.083
P	<0.001	<0.001

Group	3 days	30 days
Control	0.06±0.014	0.06±0.005
Model	0.08±0.010*	0.07±0.009*^#
Ultrasound	0.06±0.014^△	0.06±0.017^△
Non-ultrasound	0.07±0.010*^△	0.07±0.008*^△#
Sham treatment	0.08±0.006*	0.08±0.008*
KW	44.167	35.941
P	<0.001	<0.001

Group	3 days	30 days
Control	0.06±0.014	0.06±0.005
Model	0.08±0.010*	0.07±0.009*^#
Ultrasound	0.06±0.014^△	0.06±0.017^△
Non-ultrasound	0.07±0.010*^△	0.07±0.008*^△#
Sham treatment	0.08±0.006*	0.08±0.008*
KW	44.167	35.941
P	<0.001	<0.001

Group	3 days	30 days
Control	50.87±4.46	41.00±1.98
Model	37.72±1.22*	34.60±3.29
Ultrasound	42.93±2.47^△	47.85±3.57^△
Non-ultrasound	49.43±3.59	37.42±2.34^#
Sham treatment	37.25±1.98*	40.14±2.30
F/KW	4.584	10.460
P	0.006	0.033