Evidence for Ultrasound-Guided Carpal Tunnel Release

Abstract

This report is a narrative review of the clinical evidence for ultrasound (US)-guided carpal tunnel release (USGCTR) in patients with carpal tunnel syndrome (CTS). To date, there are 23 clinical publications (case reports, prospective and retrospective case series, and randomized comparative studies) on USGCTR, involving 1,072 wrists. Although many different devices have been used to perform USGCTR, current publications report > 98% clinical success rate without any documented neurovascular injuries. Of the publications, 7 were done by orthopedic surgery, 6 by physiatry, 6 by family medicine, and 1 each by interventional radiology, rheumatology, plastic surgery, and neurosurgery. There is evidence that USGCTR can improve symptom severity, improve functional outcomes, reduce scarring, shorten recovery time, and hasten return to work, even in patients undergoing bilateral release. Based on current studies, USGCTR appears to be a safe and effective method for transecting the transverse carpal ligament (TCL), with reported faster recovery and functional improvement than mini-open carpal tunnel release. It is performed by physicians from many different fields of medicine trained in USG procedures. Additional randomized controlled trials, with long-term follow-up, are needed to help to confirm the best device and technique to perform this procedure.