Purpose: To compare the clinical effectiveness of minimally invasive ultrasound (US)guided vs open release for carpal tunnel syndrome. Methods: In an open randomized controlled trial, 47 employed patients were allocated to US-guided carpal tunnel release (USCTR) and 42 to an open carpal tunnel release (OCTR) procedure. The main outcome was symptom severity measured by the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ-S). Secondary outcomes were hand functionality (BCTQ-F), nerve conduction, two-point discrimination, handgrip and pinch strength, pain (visual analog scale), work leave and complications. For BCTQ-S and BCTQ-F, minimal clinically important differences (MCID) were also considered. Follow-up duration was 12 months.Results: Mixed model analyses detected no significant differences between the two treatment arms in BCTQ-S (P = .098) while BCTQ-F scores were significantly better in the USCTR group (P = .007). This benefit was, however, not supported by the MCID data. Remaining variables were similar in the two groups except pain which was lower in USCTR at 3 months follow-up. All variables but two-point discrimination showed significant improvement after 3 months.Conclusions: Our findings reveal similar symptom relief benefits following OCTR or USCTR in these patients. The patients in our USCTR group, however, reported better hand functional status and less pain.carpal tunnel syndrome, hand, minimally invasive surgical procedures, musculoskeletal ultrasonography, nerves
| INTRODUCTIONCarpal tunnel syndrome is the most frequent compression neuropathy among employed adults in the United States, with an incidence of 6.3 cases per 10 000 full-time equivalent 1 and a cost of $45 000 to $89 000 per patient. 2 Since it is accepted that open carpal tunnel release (OCTR) is better at relieving symptoms than non-surgical therapies, 3,4 open surgical procedures are most commonly used for this purpose. The goal of surgery is to divide the flexor retinaculum (FR) to decompress the median nerve at the level of the wrist. Complications associated with OCTR surgery are post-surgical pain, dysesthesia and reduced grip strength which could be explained by a
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