Long-term Clinical Results of Carpal Tunnel Release Using Ultrasound Guidance

Abstract

Background: The purpose of this study was to determine the long-term safety and efficacy of carpal tunnel release (CTR) using ultrasound guidance in a group of patients treated by a single physician. Methods: The study group consisted of 76 consecutive CTRs performed on 47 patients between June 2017 and April 2019 for whom 1-year follow-up was available. All procedures were performed by the same operator using a single CTR technique. Outcomes included complications; Boston Carpal Tunnel Questionnaire symptom severity (BCTQ-SSS) and functional status (BCTQ-FSS) scores; Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores; and a 5-point global satisfaction score (4 = satisfied, 5 = very satisfied). Results: The 47 patients included 27 females and 20 males (ages 31-91 years). Twenty-five patients (50 hands) had simultaneous bilateral CTRs, 4 patients (8 hands) had staged bilateral CTRs, and 18 patients had unilateral CTRs. No complications occurred. Statistically and clinically significant reductions in BCTQ-SSS, BCTQ-FSS, and QDASH scores occurred by 1 to 2 weeks post-CTR and persisted at 1-year (mean 1-year changes vs. pre-CTR -2.11, -1.70, and -44.99, respectively; P < .001 for all). The mean global satisfaction score at 1-year was 4.63. Conclusions: CTR using ultrasound (US) guidance is a safe and effective procedure that produces statistically and clinically significant improvements within 1 to 2 weeks postprocedure that persist to 1 year. Furthermore, simultaneous bilateral CTRs using US guidance are feasible and may be advantageous for patients who are candidates for bilateral CTR.

Office-Based Carpal Tunnel Release Using Ultrasound Guidance in a Community Setting: Long-Term Results

“…However, the primary purpose of this investigation was to specifically document the safety and effectiveness of office-based CTR using US guidance in our community practice. Of note, the current results are similar to those reported by Leiby et al for 76 hands in 47 patients treated in the ambulatory surgery center or hospital operating room setting with the same US-guided CTR technique [ 19 ]. Second, the follow-up data reported in the current study were obtained primarily through mailed questionnaires and only 123 of 200 hands in 88 of 140 patients provided one-year follow-up.…”

“…To date, seven studies have documented the long-term (> one-year) safety and effectiveness of CTR using US guidance, including one prospective, randomized study demonstrating significantly faster recovery compared to mini-open CTR (mOCTR) [ 9 , 11 , 15 , 19 - 22 ]. However, none of these studies reported results from large patient cohorts (> 100 hands) treated in an office-based procedure room.…”

“…Many patients with CTS present with bilateral disease and some are candidates for bilateral CTRs [ 30 - 31 ]. In these patients, the ability to perform simultaneous bilateral releases offers the patient the opportunity to significantly reduce the overall episode of care [ 18 , 19 , 30 ]. In the current study, 46% (57/123) of the hands were treated as part of simultaneous bilateral procedures.…”

“…All patients tolerated the simultaneous procedures in the office-based procedure room, and there was no significant difference in clinical outcomes between hands treated as part of simultaneous procedures compared to unilateral or staged bilateral procedures. Only two of the previously mentioned seven long-term studies specifically report performing simultaneous bilateral releases [ 19 , 20 ]. Leiby et al treated 50 hands in 25 patients in either an ambulatory surgery center or hospital operating room [ 19 ], and more recently Wang et al treated 86 hands in 43 patients in a hospital setting [ 20 ].…”

“…Only two of the previously mentioned seven long-term studies specifically report performing simultaneous bilateral releases [ 19 , 20 ]. Leiby et al treated 50 hands in 25 patients in either an ambulatory surgery center or hospital operating room [ 19 ], and more recently Wang et al treated 86 hands in 43 patients in a hospital setting [ 20 ]. As with the current study, Leiby et al found no significant differences in outcomes between simultaneous bilateral releases and the other groups at one-year follow-up.…”