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 2^nd 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.).

Conclusion

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.

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