A Randomized Clinical Trialith an incidence of 1 to 3 cases and a prevalence of 50 cases per 1000 person-years, carpal tunnel syndrome is the most diagnosed entrapment neuropathy. 1,2 A course of nonsurgical treatment, is an option in carpal tunnel syndrome. When nonsurgical treatment fails to resolve the symptoms, surgery is considered a valid option. Carpal tunnel release can be considered as a first effective option if there is denervation or the patient elects surgery. 1,3-5 When comparing carpal tunnel release techniques with different incision lengths, smaller incisions show a faster return to work, better cosmetic results, 6,7 and lower pain rates. 4,[8][9][10][11][12] Incision sizes Jose Manuel Rojo-Manaute, MD, PhD, Alberto Capa-Grasa, MD, PhD, Francisco Chana-Rodríguez, MD, PhD, Ruben Perez-Mañanes, MD, PhD, Guillermo Rodriguez-Maruri, MD, Pablo Sanz-Ruiz, MD, PhD, Jorge Muñoz-Ledesma, MD, Mikel Aburto-Bernardo, MD, Luis Esparragoza-Cabrera, MD, Miguel del Cerro-Gutiérrez, MD, PhD, Javier Vaquero-Martín, MD, PhD Received July 2, 2015, ORIGINAL RESEARCHObjectives-The purpose of this study was to compare the outcomes of 1-mm ultraminimally invasive ultrasound-guided carpal tunnel release and 2-cm blind mini-open carpal tunnel release.Methods-We conducted a single-center individual parallel-group controlled-superiority randomized control trial in an ambulatory office-based setting at a third-level referral hospital. Eligible participants had clinical signs of primary carpal tunnel syndrome and positive electrodiagnostic test results and were followed for 12 months. Independent outcome assessors were blinded. Patients were randomized by concealed allocation (1:1) by an independent blocked computer-generated list. The postoperative score on the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was the primary variable. Grip strength and time for discontinuation of oral analgesics, complete wrist flexion-extension, relief of paresthesia, and return to normal daily activities (including work) were assessed. Conclusions-Ultra-minimally invasive carpal tunnel release provides earlier functional return and less postoperative morbidity with the same neurologic recovery as mini-open carpal tunnel release for patients with symptomatic primary carpal tunnel syndrome.

With adequate anatomic knowledge, technical training, and a basic ultrasound machine, sonographically guided A1 pulley release can be performed safely and successfully, offering an alternative to classic open surgery in the ambulatory setting.

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This trial comparing surgical models was underpowered and is inconclusive on turnover times; however, the sonographically guided-office-based approach showed shorter turnover times and better economic results with a quick recoup of the costs of sonographically assisted surgery.