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

Abstract

Objectives: To report the safety and effectiveness of office-based carpal tunnel release (CTR) using ultrasound (US) guidance in a general community population. Methods: This was a prospective single-center study that evaluated patients treated with CTR using US guidance between March 2019 and August 2020 for whom one-year data were available. Procedures were performed in an office-based procedure room using local anesthesia. Main outcomes of this study included complications, Boston Carpal Tunnel Questionnaire scores (BCTQ-SSS, BCTQ-FSS) and Quick Disabilities of the Shoulder and Hand (QDASH) scores. Results: Among 88 patients (123 hands) aged 30 to 89 years with available one-year data, 29 patients had simultaneous bilateral procedures. No intraoperative complications were reported. Statistically significant and clinically important improvements in BCTQ-SSS, BCTQ-FSS and QDASH scores occurred within two weeks and persisted through one year of follow-up (p < 0.001). Outcomes were similar for simultaneous bilateral releases. During follow-up, one patient developed complex regional pain syndrome that was successfully treated and subsequently had CTR using US guidance on the contralateral hand. No other complications were observed during one-year follow-up. Conclusion: Office-based CTR using US guidance is safe, effective and provides sustained clinical improvements at one-year follow-up in a community population. Simultaneous bilateral procedures were well-tolerated and resulted in similar clinical improvements.

Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique

“…The 1-year results with CTR-US in this trial corroborate the long-term results reported in single-arm CTR-US studies 8–11 that reported sustained and clinically important improvements in CTS symptoms with a low rate of complications (Table 2). In this trial, more than one in four patients assigned to mOCTR withdrew before treatment because they did not desire mOCTR despite initially consenting to randomization.…”

“…This learning curve with CTR-US is consistent with previous studies demonstrating proficiency by providers with a wide range of prior experience in ultrasound and CTR. 10,23 While the substantial difference in surgeon experience precluded statistically analyzing its impact on trial results, comparing CTR-US and mOCTR outcomes among similarly experienced surgeons would be informative.…”

“…Carpal tunnel release with ultrasound guidance (CTR-US) uses a small (<1 cm) wrist incision with real-time ultrasonography to visualize the relevant anatomy during the procedure. While numerous case series have reported favorable outcomes with CTR-US, [8][9][10][11] randomized trials provide higher-quality evidence to inform clinical decisionmaking. Two previous single-center randomized trials evaluated patient-reported outcomes and complication rates with CTR-US and mOCTR.…”

Protocol of a Multicenter Prospective Trial of Office-Based Carpal Tunnel Release With Ultrasound Guidance (ROBUST)

“…Ultrasound helps the operator perform the procedure through a small incision while providing an expanded field of view, including multiplanar and dynamic views, compared to endoscopic and similar small incision techniques. Numerous studies have demonstrated the safety and effectiveness of CTR-US for the treatment of CTS [8][9][10][11][12], yet clinical outcomes with this procedure when performed in-office are not well characterized. A prospective single-center study demonstrated the feasibility of CTR-US when performed in an office-based setting [8].…”

“…Numerous studies have demonstrated the safety and effectiveness of CTR-US for the treatment of CTS [8][9][10][11][12], yet clinical outcomes with this procedure when performed in-office are not well characterized. A prospective single-center study demonstrated the feasibility of CTR-US when performed in an office-based setting [8]. The improvement in CTS symptoms following office-based CTR-US was statistically significant and clinically important over one year of follow-up, and no intraoperative complications or reoperations were reported.…”