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Dec 26, 2023

Journal Watch: New Long-Term Real World Safety Data on Carpal Tunnel Release Using Ultrasound Guidance

Carpal tunnel syndrome is the most common compressive neuropathy in the United States with a reported prevalence of 3-8% (Sevy et al.; Atroshi et al.; Luckhaupt et al.; Dale et al.), and carpal tunnel release is of the most common surgeries with more than 600,000 procedures performed annually (Atroshi et al.; Fajardo et al.).

Historically, most carpal tunnel releases have been performed using a traditional open or mini-open technique (Li et al.; Munns and Awan; Leinberry et al.; Schwarz et al.; Hacquebord et al.). Although carpal tunnel surgery has a high patient satisfaction and low complication rate, there is a desire to reduce the size of the incision and improve recovery (Fajardo et al.; Leiby et al.; Li et al.; Michelotti et al.).

Carpal tunnel release using ultrasound guidance is a more recent technique that uses a small incision, while still allowing visualization of critical neurovascular structures using real time ultrasound. Previous studies have demonstrated safety and efficacy of these newer ultrasound guided carpal tunnel release techniques, but follow-up of these studies was limited to 6-months (Leiby et al.; Rojo-Manaute et al.; Fowler et al.; Capa-Grasa et al.; Bergum and Ciota).

In a recent study by Aguila et al. (2023) the authors reported 1-year outcomes using a multi-center registry on the safety and efficacy of carpal tunnel release using ultrasound guidance. In this study, all patients were treated with the UltraGuideCTR hand-held device manufactured by Sonex. The procedure is performed under local anesthesia using a small incision at the wrist. The device allows the carpal tunnel release to be performed using ultrasound to identify the relevant neurovascular structures and after confirming the device positioning small balloons are deployed to create space between the blade and nerve, and then the device makes a cut to release the transverse carpal ligament.

Postoperative data was collected by text message, email and chart review at baseline, daily text message the first 14 days, and then at 2-weeks, 1, 3, 6-months and 1-year after surgery. Complications included superficial and deep infection, arterial laceration, nerve injury and reoperation were recorded. Of the 959 patients enrolled in the registry, 300 patients (341 hands) had 1-year postoperative data. At 1-year 87.7% of patients were satisfied with the procedure.

Complications were reported in 1.33% of patients, including 2 patients that required a 2nd surgery due to an incomplete release, 1 deep infection and one suspected tendon injury. The results in this study were similar to outcomes reported to open and endoscopic carpal tunnel release (Trumble et al.; Atroshi et al.). Revision rates for open and endoscopic carpal tunnel release vary in the literature and range from <1% to 5% (Wessle et al.; Carroll et al.).


The authors concluded that carpal tunnel release using ultrasound guidance produced statistically significant and clinically meaningful improvement in symptoms and function that persisted long term and had a high satisfaction.


Aguila D, Kirsch M, Kindle B, Paterson P. Long-Term Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance: A Multicenter Pragmatic Study. J Hand Surgery Global Online. 2023. Online.

Atroshi I, Englund M, Turkiewicz A, Tagil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med. 2011;171(10):943e944.

Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosen I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999;282(2): 153e158.

Atroshi I, Larsson GU, Ornstein E, Hofer M, Johnsson R, Ranstam J. Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: randomised controlled trial. BMJ. 2006;332(7556):1473.

Bergum RA, Ciota MR. Office-based carpal tunnel release using ultrasound guidance in a community setting: long-term results. Cureus. 2022;14(7): e27169.

Capa-Grasa A, Rojo-Manaute JM, Rodriguez FC, Martin JV. Ultra minimally invasive sonographically guided carpal tunnel release: an external pilot study. Orthop Traumatol Surg Res. 2014;100(3):287e292.

Carroll TJ, Dussik CM, Clary Z, Hoffman S, Hammert W, Mahmood B. Endoscopic versus open carpal tunnel surgery: risk factors and rates of revision surgery. J Hand Surg Am. 2023;48(8):757e763.

Dale AM, Harris-Adamson C, Rempel D, et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: pooled analysis of six prospective studies. Scand J Work Environ Health. 2013;39(5):495e505.

Fajardo M, Kim SH, Szabo RM. Incidence of carpal tunnel release: trends and implications within the United States ambulatory care setting. J Hand Surg Am. 2012;37(8):1599e1605.

Fowler JR, Chung KC, Miller LE. Multicenter pragmatic study of carpal tunnel release with ultrasound guidance. Expert Rev Med Devices. 2022;19(3): 273e280.

Hacquebord JH, Chen JS, Rettig ME. Endoscopic carpal tunnel release: techniques, controversies, and comparison to open techniques. J Am Acad Orthop Surg. 2022;30(7):292e301.

Leiby BM, Beckman JP, Joseph AE. Long-term clinical results of carpal tunnel release using ultrasound guidance. Hand (N Y). 2022;17(6):1074e1081.

Leinberry CF, Rivlin M, Maltenfort M, et al. Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: a 25-year perspective. J Hand Surg Am. 2012;37(10):1997e2003 e3.

Li Y, Luo W, Wu G, Cui S, Zhang Z, Gu X. Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2020;21(1):272.

Luckhaupt SE, Dahlhamer JM, Ward BW, Sweeney MH, Sestito JP, Calvert GM. Prevalence and work-relatedness of carpal tunnel syndrome in the working population, United States, 2010 National Health Interview Survey. Am J Ind Med. Jun 2013;56(6):615e624.

Michelotti BM, Vakharia KT, Romanowsky D, Hauck RM. A prospective, randomized trial comparing open and endoscopic carpal tunnel release within the same patient. Hand (N Y). 2020;15(3):322e326.

Munns JJ, Awan HM. Trends in carpal tunnel surgery: an online survey of members of the American Society for Surgery of the Hand. J Hand Surg Am. 2015;40(4):767e771 e2.

Rojo-Manaute JM, Capa-Grasa A, Chana-Rodriguez F, et al. Ultra-minimally invasive ultrasound-guided carpal tunnel release: a randomized clinical trial. J Ultrasound Med. 2016;35(6):1149e1157.

Sevy JO, Varacallo M. Carpal Tunnel Syndrome. StatPearls Publishing [Internet]; 2022.

Schwarz AM, Lipnik G, Hohenberger GM, Krauss A, Plecko M. Mini-open carpal tunnel release: technique, feasibility and clinical outcome compared to the conventional procedure in a long-term follow-up. Sci Rep. 2022;12(1):9122.

Trumble TE, Diao E, Abrams RA, Gilbert-Anderson MM. Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial. J Bone Joint Surg Am. 2002;84(7):1107e1115.

Wessel LE, Gu A, Asadourian PA, Stepan JG, Fufa DT, Osei DA. The epidemiology of carpal tunnel revision over a 1-year follow-up period. J Hand Surg Am. 2021;46(9):758e764.

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