# US 2014/0193394 A1 · Treatment of carpal tunnel syndrome by injection of the flexor retinaculum > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2014/0193394 A1 - Document ID: US20140193394A1 - Status: Published application - Kind: A1 - Application number: 14/153,785 - Filed: 2014-01-13 - Published: 2014-07-10 - Earliest claimed: 2009-03-25 - Assignees: John M. Agee, Trustee of the John M. Agee Trust of August 15, 1996 - Applicants: John M. Agee, Trustee of the John M. Agee Trust of August 15, 1996 - Inventors: John M. Agee; Ben C. Goss; Francis C. King; Jeffrey Woodhouse - Web page: https://patentgrep.com/patent/US20140193394A1 ## CPC - A61M 5/427: {Locating point where body is to be pierced, e.g. vein location means using ultrasonic waves, injection site templates} - A61B 17/32: Surgical cutting instruments ({A61B18/042 takes precedence; suture cutters A61B17/0467;} implements for ligaturing and cutting {A61B17/122, A61B17/12; instruments for rupturing the amniotic membrane A61B17/4208; specially adapted knives for eye surgery A61F9/0133}) - A61B 17/320036: {adapted for use within the carpal tunnel} - A61B 17/3403: {Needle locating or guiding means} - A61K 9/0019: {Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner (non-active ingredients are additionally classified in A61K47/00)} - A61K 31/56: Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids - A61K 38/4886: {Metalloendopeptidases (3.4.24), e.g. collagenase} - A61M 5/52: Arm-rests - A61P 19/00: Drugs for skeletal disorders - A61B 2017/3413: {guided by ultrasound} - A61M 2210/083: Arms - A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - A61K: PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES (devices or methods specially adapted for bringing pharmaceutical products into particular physical or administering forms A61J3/00; chemical aspects of, or use of materials for deodorisation of air, for disinfection or sterilisation, or for bandages, dressings, absorbent pads or surgical articles A61L; soap compositions C11D) - A61P: SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS ## Abstract An apparatus and method for identifying the flexor retinaculum of the carpal tunnel, injecting an effective amount of an agent into at least a portion of flexor retinaculum or tissue adjacent thereto, wherein the agent is configured to weaken the flexor retinaculum. The system may further include means for increasing the tensile stress in the flexor retinaculum post-injection using hand exercises, thereby weakening its structural integrity and decreasing the pressure within the carpal tunnel that impairs median nerve function. ## Claims ### Claim 1 A method for treating a patient with carpal tunnel syndrome, comprising: identifying a location of the patient's flexor retinaculum suitable for treatment; and injecting an agent into said location of the flexor retinaculum in one or more doses sufficient to weaken the structural integrity of the flexor retinaculum; wherein the agent comprises one or more doses of collagenase. ### Claim 2 (canceled) ### Claim 3 (depends on 1) A method as recited in claim 1, wherein the agent further comprises a corticosteroid. ### Claim 4 (depends on 1) A method as recited in claim 1, wherein identifying a suitable treatment location of the patient's flexor retinaculum comprises: positioning an imaging detector adjacent a region of the patient's hand; the region being associated with the flexor retinaculum, and generating an image of the patient's hand. ### Claim 5 (depends on 1) A method as recited in claim 1, wherein the flexor retinaculum includes the transverse carpal ligament. ### Claim 6 (depends on 1) A method as recited in claim 1, wherein the flexor retinaculum includes its attachment to the bones. ### Claim 7 (depends on 4) A method as recited in claim 4, wherein generating an image comprises positioning an ultrasound transducer adjacent the patient's hand and generating an ultrasound image. ### Claim 8 (depends on 1) A method as recited in claim 1, further comprising: increasing the tensile stress in the flexor retinaculum subsequent to injecting said agent. ### Claim 9 (depends on 8) A method as recited in claim 8, wherein the increase in tensile stress is generated by pressure within the carpal tunnel, said pressure generated by one or more of the following: having the patient use one or more digits of the hand, having the patient grip the hand around an object; flexing one or more fingers into the palm of the hand and having the patient pinch a thumb and one or more fingers of the hand together. ### Claim 10 (depends on 9) A method as recited in claim 9, wherein the object comprises a dynamometer. ### Claim 11 (depends on 9) A method as recited in claim 9, wherein the object is pressed into the palm or heel of the patient's hand. ### Claim 12 (depends on 1) A method as recited in claim 1, further comprising: measuring pressure within the carpal tunnel. ### Claim 13 (depends on 1) A method as recited in claim 1, further comprising: cutting the flexor retinaculum with a blade. ### Claim 14 (depends on 4) A method as recited in claim 4: wherein identifying a suitable treatment location of the patient's flexor retinaculum further comprises computing the palmer-to-dorsal depth from the palm of the hand to the flexor retinaculum; and wherein the agent is injected via a needle at said computed palmer-to-dorsal depth along an axis substantially parallel to an imaging surface of the detector. ### Claim 15 (depends on 1) A method as recited in claim 1: wherein identifying a suitable treatment location of the patient's flexor retinaculum further comprises computing the palmer-to-dorsal depth from the palm of the hand to the flexor retinaculum; and wherein the agent is injected via a needle at said computed palmer-to-dorsal depth along an axis substantially parallel to a longitudinal axis of the flexor retinaculum. ### Claim 16 (depends on 1) A method as recited in claim 1, wherein the agent is delivered at a central portion of the flexor retinaculum. ### Claim 17 (depends on 1) A method as recited in claim 1, further comprising: inserting a guide tube into the hand adjacent the flexor retinaculum; and accessing the flexor retinaculum at the distal end of the guide tube. ### Claim 18 (depends on 17) A method as recited in claim 17, further comprising: advancing a pressure sensor within said guide tube to said treatment location; and measuring the pressure at said location. ### Claim 19 (depends on 17) A method as recited in claim 17, further comprising: advancing a cutting probe within said guide tube to said treatment location; and cutting tissue associated with the flexor retinaculum. ### Claim at position 20 20-44. (canceled)