Ultrasound‐guided percutaneous carpal tunnel release: A systematic review

Abstract

Objective Carpal tunnel syndrome (CTS) is the most common peripheral entrapment mononeuropathy. The purpose of this systematic review is to evaluate the reported clinical effectiveness and safety of ultrasound‐guided percutaneous carpal tunnel release (USCTR) for the treatment of CTS. Literature Survey PubMed, EMBASE, and ScienceDirect databases were queried from database inception to February 20, 2021, to identify clinical studies on USCTR. Methodology Two reviewers independently completed title, abstract, and full‐text screening, and they extracted data in duplicate for analysis. Procedure techniques, outcome measures, and complications were descriptively analyzed. Synthesis Eighty‐seven studies were eligible for screening. Twenty studies (three randomized controlled trials, three prospective cohort studies, and 14 case series) met inclusion criteria, with a total of 1772 USCTR cases. The overall level of evidence was very low, with seven studies with at least moderate risk of bias. Thirteen studies exceeded the minimal clinically important difference (MCID) for the Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ‐SS) and Boston Carpal Tunnel Questionnaire Functional Status Scale (BCTQ‐FS), and six studies exceeded the MCID for the Quick Disabilities of Arm, Shoulder & Hand (QDASH). Five studies reported statistically significant improvement in these functional outcome measures as early as the first week post‐procedure. A major complication occurred in one patient who developed suspected compartment syndrome, and minor complications were reported in 24 patients. Conclusions Based on very low level of evidence, early studies suggest that USCTR may be an effective treatment for CTS, with potential for short post‐procedure recovery times.

Ultrasound-Guided Modified Thread Carpal Tunnel Release for Carpal Tunnel Syndrome: A Pilot Study

“…Previous studies have reported that TCTR provides better outcomes, faster recovery, and quicker return to work than open CTR or endoscopic CTR [13,14,15,16]. Most patients experienced a reduction in pain within 12 h after TCTR.…”

Understanding the Learning Curve of Carpal Tunnel Release With Ultrasound Guidance: A Review

“…CTR-US represents an increasingly popular treatment for CTS [ 25 ], which may be able to provide the benefits of ECTR while avoiding the limitations of ECTR such as a reduced field of view [ 26 ]. Although CTR-US was first described as early as 1997 [ 27 ], recent advances in the quality, availability, and affordability of ultrasound technology have allowed this technique to become more commonly studied [ 6 , 25 ]. The primary advantage of CTR-US is the ability of the provider to identify all relevant anatomical landmarks despite being a minimally invasive technique [ 28 ].…”

“…Variable rates of revision surgical procedures have been reported, ranging from less than 1% to 12% [ 4 ]; most studies report revision rates between 0.5% and 1.5% [ 5 ]. While traditional open CTR is the most common surgical technique used to treat CTS, newer techniques, such as carpal tunnel release using real-time ultrasound guidance (CTR-US), may offer some advantages with accelerated recovery in the postoperative period [ 6 ]. As with any new technique, some potential adopters may have questions pertaining to the learning curve of the procedure [ 7 ].…”

Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study

“…With the development of interventional procedures using high-frequency ultrasound, ultrasound-guided percutaneous carpal tunnel release (USCTR) using various dividing instruments was proposed to overcome these limitations of OCTR and ECTR [ 6 ]. Among the USCTR, the thread carpal tunnel release (TCTR) was first proposed by Danqing Guo and his colleagues [ 7 ], which can transect the TCL without skin incision, leaving only two needle punctures [ 8 ].…”