Imaging and therapeutic procedure for carpal tunnel syndrome

• US 7,303,555 B2
• Filed: 06/30/2004
• Issued: 12/04/2007
• Est. Priority Date: 06/30/2003
• Status: Active Grant

• Current Assignee: Depuy Products Incorporated (Johnson & Johnson)
• Original Assignee: Depuy Products Incorporated (Johnson & Johnson)
• Inventors: Makin, Inder Raj S., Dunki-Jacobs, Robert J., Stephens, Sarah E., Klotz, Conrad Lee
• Primary Examiner(s): PEFFLEY, MICHAEL F
• Application Number:
  US10/881,409
• Publication Number:
  US 20050038423A1
• Time in Patent Office: 1,252 Days
• Field of Search: 606/1, 606/27, 606/28, 606/41, 606/46, 600/439, 600/471, 600/1, 128/898
• US Class Current: 606/28
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 8/14 Echo-tomography
• CPC Class Codes: A61N 2007/0078 with multiple treatment transducers
• CPC Class Codes: A61N 7/02 Localised ultrasound hyperthermia hyperthermia in general A61F7/00

Abstract

A system, method and/or apparatus is provided for visualization or imaging of the transverse carpal ligament and surrounding structures/features of a hand of a patient, and treatment of the transverse carpal ligament, particularly, but not necessarily, for performing non-invasive carpal tunnel release. The subject invention utilizes ultrasound waves preferably, but not necessarily, in the high frequency range and cavitations to image the transverse carpal ligament (TCL), record its location in three-dimensional space, and perform precision treatment on the transverse carpal ligament. Treatment may range from stretching or lengthening the TCL to complete tissue ablation or dissection of a portion or portions of the TCL (as is performed in a standard carpal tunnel release procedure) in order to release pressure within the carpal tunnel. Particularly, high temperature conditions are generated at target tissue of the TCL resulting in elongation or necrosis/dissection. The subject system, apparatus and/or method provides the surgeon to relieve a patient of carpal tunnel syndrome symptoms in a bloodless, efficient, and accurate manner.

Claims

1. A method for visualization and treatment of a transverse carpal ligament and surrounding structures/features of a patient comprising:

placing a probe at a first position with respect to a wrist;

transmitting a first frequency signal to a carpal tunnel area of the wrist using the probe positioned at the first position;

generating an ultrasonic image of the carpal tunnel area of the wrist with the first frequency signal;

identifying a target area of the carpal tunnel area using the generated ultrasonic image;

moving the probe from the first position to a second position with respect to the wrist, the second position at a location different from the first position; and

transmitting a second frequency signal to the target area using the probe positioned at the second position, wherein the second frequency signal is at a frequency different from the first frequency signal and is selected to cause at least one of ablation, elongation, necrosis and dissection within the target area.

2. The method of claim 1 wherein the target area identification includes imaging the target area with magnetic resonance imaging.

3. The method of claim 1 wherein the second frequency signal is transmitted in the form of an ellipsoid field.

4. The method of claim 1 wherein the second frequency signal is transmitted in the form of a circular spot field.

5. The method of claim 1 wherein the second frequency signal is transmitted in the form of a rectangular spot field.

6. The method of claim 1 wherein the transmittal of the second frequency signal is performed with a second transducer;

and

the transmittal of the first frequency signal is performed with a first transducer.

7. The method of claim 1 further comprising:

administering drug therapy before transmitting the second frequency signal to the target area.

8. The method of claim 7 wherein the drug therapy administration is ingesting of a medication prior to the transmission of the second frequency signal to the target area.

9. The method of claim 8 wherein the medication ingested is one of an analgesic and an anti-inflammatory drug.

10. The method of claim 8 wherein the drug therapy administration is injection of a drug to the target area before the transmission of the second frequency signal to the target area.

11. The method of claim 1 wherein the transmission steps are performed with epidermal contact between an ultrasound probe and the skin in the vicinity of the transverse carpal ligament.

12. The method of claim 11 wherein the transmission steps are performed with one of a linear array, curved array, or a tightly curved area probe.

13. The method of claim 1 further comprising:

defining multiple frequencies for transmission to the target area;

specifying a duration for the transmission of each defined frequency; and

transmitting each defined frequency for the specified transmission duration.

14. The method of claim 1 further comprising:

selecting at least one parameter to be measured for the target area; and

measuring the selected parameter following transmission of the second frequency signal to determine the effectiveness of the second frequency signal transmission.

15. The method of claim 14 wherein the at least one parameter is selected from the group comprised of target area density, acoustic speed through the target area, signal attenuation in the target area, and linearity of the target area'"'"'s response to the frequency signal.

16. The method of claim 14 further comprising:

measuring an initial condition for the selected at least one parameter for a baseline;

establishing a change parameter for the selected at least one parameter; and

determining whether a measured value of the selected parameter during transmission of the second frequency signal to the target area is approximately the value of the established change parameter.

17. The method of claim 1 wherein the target area identification includes imaging the target area with spatial compound ultrasound imaging.

18. The method of claim 1 wherein the target area identification includes imaging the target area with a computed tomography scan.

19. The method of claim 1 wherein the transmission of the second frequency signal to the target area is performed subcutaneously.