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Jan 09, 2024

Journal Watch: New Systematic review of Ultrasound Guided Percutaneous Carpal Tunnel Release

Carpal tunnel syndrome affects 3.8% of the general population (Atroshi et al.), and can cause symptoms of numbness, paresthesias, pain and weakness. In the United States, over 500,000 carpal tunnel releases are performed annually to relieve pressure on the median nerve (Fajardo et al.).

Traditionally, carpal tunnel releases are performed using an open, mini-open or endoscopic surgical approach. An ultrasound guided approach was first described in 2005, that relies on ultrasound to visualize the nerve and at risk structures (Rowe et al.).

In a recent systematic review, Choe et al. analyzed 20 studies (1772 cases). The authors found that carpal tunnel release with ultrasound guidance to be safe with only one major complication (compartment syndrome after using a hook knife) and 24 minor complications (self-limited pain and swelling, infection, transient paresthesias). The one major complication occurred after the patient played racquetball, opening the possibility that this was a superimposed injury due to lack of activity restriction and not related to the procedure (Kamel et al.). No permanent neurovascular injuries were reported. In comparison, major complications after open carpal tunnel release and endoscopic release were 1.0% and 0.9% and minor complications 10.3% and 4.9% (Vasiliadis et al.).

The authors reported a shorter return to work with 5 studies reporting a return to work as early as the first week after the procedure (Guo et al.; Hebbard et al.; Guo et al.; Rojo-Manaute et al.; Capa-Grasa et al.). Two studies showed a shorter average return to work with the ultrasound guided approach when compared to the mini-open procedure (Rojo-Manaute et al.; Capa-Grasa et al.). In addition, bilateral release is a viable option with the ultrasound guided approach with similar outcomes as a unilateral staged bilateral carpal tunnel release (Leiby et al.). Patients who were crutch or wheelchair ambulators were also able to transfer immediately after the procedure (Henning et al.).


Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA. 1999 Jul 14;282(2):153-8.

Capa-Grasa A, Rojo-Manaute JM, Rodríguez FC, Martín JV. Ultra minimally invasive sonographically guided carpal tunnel release: an external pilot study. Orthop Traumatol Surg Res. 2014 May;100(3):287-92.

Chou RC, Robinson DM, Homer S. Ultrasound-guided percutaneous carpal tunnel release: A systematic review. PM R. 2023 Mar;15(3):363-379.

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 Aug;37(8):1599-605.

Guo D, Guo D, Guo J, Schmidt SC, Lytie RM. A Clinical Study of the Modified Thread Carpal Tunnel Release. Hand (N Y). 2017 Sep;12(5):453-460.

Guo D, Tang Y, Ji Y, Sun T, Guo J, Guo D. A non-scalpel technique for minimally invasive surgery: percutaneously looped thread transection of the transverse carpal ligament. Hand (N Y). 2015 Mar;10(1):40-8.

Hebbard P, Thomas P, Fransch SV, Cichowitz A, Franzi S. Microinvasive Carpal Tunnel Release Using a Retractable Needle-Mounted Blade. J Ultrasound Med. 2021 Jul;40(7):1451-1458.

Henning PT, Yang L, Awan T, Lueders D, Pourcho AM. Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: Preliminary Clinical Results. J Ultrasound Med. 2018 Nov;37(11):2699-2706.

Kamel SI, Freid B, Pomeranz C, Halpern EJ, Nazarian LN. Minimally Invasive Ultrasound-Guided Carpal Tunnel Release Improves Long-Term Clinical Outcomes in Carpal Tunnel Syndrome. AJR Am J Roentgenol. 2021 Aug;217(2):460-468.

Leiby BM, Beckman JP, Joseph AE. Long-term Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance. Hand (N Y). 2022 Nov;17(6):1074-1081.

Rojo-Manaute JM, Capa-Grasa A, Chana-Rodríguez F, Perez-Mañanes R, Rodriguez-Maruri G, Sanz-Ruiz P, Muñoz-Ledesma J, Aburto-Bernardo M, Esparragoza-Cabrera L, Cerro-Gutiérrez MD, Vaquero-Martín J. Ultra-Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: A Randomized Clinical Trial. J Ultrasound Med. 2016 Jun;35(6):1149-57.

Rowe NM, Michaels J 5th, Soltanian H, Dobryansky M, Peimer CA, Gurtner GC. Sonographically guided percutaneous carpal tunnel release: an anatomic and cadaveric study. Ann Plast Surg. 2005 Jul;55(1):52-6; discussion 56.

Vasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP, Brassington R, Scholten RJ, Salanti G. Endoscopic and Open Release Similarly Safe for the Treatment of Carpal Tunnel Syndrome. A Systematic Review and Meta-Analysis. PLoS One. 2015 Dec 16;10(12):e0143683.

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