Carpal Tunnel Release with Ultrasound Guidance Versus Open and Mini-Open Carpal Tunnel Release: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Purpose: Carpal tunnel release (CTR) can be performed using several techniques, including traditional open CTR, mini-open CTR, endoscopic CTR (ECTR), and CTR with ultrasound guidance (CTR-US). Carpal tunnel release with ultrasound guidance allows the procedure to be performed through a small, nonpalmar incision while maintaining visualization of critical anatomy and may confer benefits in terms of early recovery and incision-related complications. The objective of this study was to compare CTR-US with traditional open or mini-open CTR based on evidence from randomized controlled trials (RCTs). Methods: The electronic databases Embase and MEDLINE were searched from inception to November 2022. Randomized controlled trials comparing CTR-US with traditional open or mini-open CTR were eligible for inclusion. Studies were assessed for eligibility from title and abstract followed by a full-text review. The main outcomes of interest were return to normal activity or return to work, patient-reported functional scores, and complications. Results: Three RCTs were eligible for inclusion with a total of 221 patients randomized. Meta-analysis demonstrated that compared with open CTR patients, patients treated with CTR-US had significantly higher functional scores at 3 months (standardized mean difference: -0.91, 95% confidence interval (CI): -1.38 to -0.44, P < .01) and faster return to normal activities (mean difference: -20.8 days, 95% CI: -21.77 to -19.73). There was no significant difference in complication rates between the two groups (odds ratio: 0.80, 95% CI: 0.04-15.10, P = .07). No domains were deemed to be at high risk of bias in any study. Conclusions: Based on the available evidence, CTR-US is a safe and effective surgical option for treating carpal tunnel syndrome with a similar risk profile to open CTR. Data suggest that patients who receive CTR-US have improved functional outcomes and faster return to work or normal activities. Future RCTs with larger sample sizes are needed to corroborate these benefits and demonstrate long-term outcomes of CTR-US. Type of study/level of evidence: Therapeutic II.