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

Abstract

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.

Local injection therapy for carpal tunnel syndrome: a network meta-analysis of randomized controlled trial

“…By contrast, most of the studies on D5W included in this paper used 5 mL, and it is therefore uncertain as to whether an injection volume higher than 5 mL would provide better results. The same conclusion was reached in a systematic review by Lam et al, and CS was found to be superior to lower doses in the high-dose group ( Lam et al, 2023 ). Further research should directly compare different injection volumes of PRP, D5W, and CS to determine their optimal dose.…”

Ultrasonographic Contrast and Therapeutic Effects of Hydrogen Peroxide-Responsive Nanoparticles in a Rat Model with Sciatic Neuritis

“…54,55 However, physicians remain concerned regarding possible steroid-related adverse effects, including hyperglycemia, axonal and myelin degeneration, skin thinning, myopathy, soft tissue atrophy, steroid flares, crystal-induced synovitis, and hypersensitivity reactions. 56,57 In general, the therapeutic effect of perineural steroid injections is relatively short-lived (<3 months) and repeated use is common in clinical practice, amplifying related concerns. [58][59][60] Moreover, alternative medications, such as dextrose or plateletrich plasma, as well as hydrodissection therapy, have been explored; however, their comparative advantage remains controversial owing to different methodologies and conflicting conclusions.…”

“…[58][59][60] Moreover, alternative medications, such as dextrose or plateletrich plasma, as well as hydrodissection therapy, have been explored; however, their comparative advantage remains controversial owing to different methodologies and conflicting conclusions. 56,59,61 Therefore, the development of novel therapeutic agents is of great interest.…”

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

“…CTS is also considered the most costly and disabling upper-extremity musculoskeletal disorder in Western countries. It causes substantial expenses incurred via medical insurance, lost wages, diminished productivity, and increasing disability in affected individuals [3].…”