Minimally invasive ultrasound‐guided vs open release for carpal tunnel syndrome in working population: A randomized controlled trial

Abstract

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

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

“…Of the 24 included studies for UPCTR, ( Table 8 ) there were four RCTs [ 63 , 64 , 65 , 66 ]: two investigated UPCTR using a hook knife vs. mini-OCTR [ 63 , 64 ]; one compared miniscalpel needles plus steroid injection with corticosteroid injection only [ 65 ]; and one evaluated a U-shaped probe/trough plus 5 mm Dovetail blades vs. OCTR [ 66 ]. There were four case-cohort UPCTR studies [ 17 , 70 , 71 , 72 ]: one compared UPCTR with mini-OCTR [ 17 ]; one investigated UPCTR vs. OCTR [ 72 ]; one evaluated UPCTR using a 22 G hypodermic needle vs. UPCTR plus corticosteroid injection [ 70 ]; and the last case-cohort study compared the use of a UPCTR of an uncoated multifilament stainless steel wire looped thread with no interventions [ 71 ].…”

“…Five clinical trials utilized the ZX-One MicroKnife (Sonex Health, Eagen, MN, USA), which has inflatable balloon buffers [ 80 , 83 , 85 , 86 , 88 ]. Three other studies employed K-wires [ 63 , 64 , 81 ], two with a Penfill curved elevator [ 85 , 88 ], one with a uterine dilator [ 86 ], one with a U-shaped trough/probe [ 66 ], and one with a button tip cannula with hydrodissection to enlarge the safe zone [ 89 ].…”

“…Kamel et al [ 86 ] reported that nearly 39% of patients needed two passes for a complete transection in the presence of a markedly thickened FR. Among the studies using anterograde blades, Fuente et al and Nakamichi et al employed a single passage to divide the FR [ 17 , 66 ], whereas Hebbard et al [ 84 ] used two to three passes to completely transect the FR. The studies using multiple fenestrations with a needle reported requiring 10–15 fenestrations for a complete UPCTR [ 65 ].…”

“…Seventeen of the included studies used the BCTQ [ 133 ] for pre- and post-procedural assessment of the severity of the symptoms [ 65 , 66 , 71 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 ]. Significant improvements in the BCTQ symptom severity scale and functional status scale were reported as early as one week after UPCTR [ 78 , 85 , 88 ], and the statistical significance was maintained for up to 2 years [ 82 , 87 ].…”

Ultrasound-Triggered on Demand Lidocaine Release Relieves Postoperative Pain

“…Ultrasound, as an integral part of drug-delivery modalities, has many attractive features, including simplicity and cost-effectiveness ( Covotta et al, 2020 ). Sonication can be performed non-invasively, and ultrasound waves can be directed to deep locations for precise energy-deposition patterns ( de la Fuente et al, 2021 ; Mi et al, 2021 ). In early studies, microbubbles, which are clinically recognized as ultrasound contrast agents, were used to load therapeutic agents for effective tumor chemotherapy.…”