Minimally invasive ultrasound-guided carpal tunnel release: long-term clinical outcomes

Abstract

Purpose

In cases of severe or refractory carpal tunnel syndrome (CTS), carpal tunnel release (CTR) can be performed using open surgery, endoscopic techniques, or minimally invasive approaches under high-resolution ultrasound (HRUS) guidance. This study aimed to evaluate the long-term clinical outcomes following HRUS-guided CTR.

Materials and Methods

A retrospective analysis was conducted on 302 HRUS-CTR cases. Patients who were available for a phone interview and had a minimum follow-up period of one year were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Symptom severity and functional limitations were compared before and after the procedure.

Results

Of the 302 cases screened, 111 cases had to be excluded due to unavailability for the phone call, missing data, or death. Accordingly, 191 cases were included. The average patient age was 60.4 ± 15.5 years (range: 19 to 87 years). 126 cases (66%) were female and 65 cases (34.0%) were male. Overall, there was a significant reduction of 91.9% in CTS-related symptom severity and frequency for all items recorded in the questionnaire. Similarly, a significant reduction of 84.8% in difficulty with all self-reported daily activities was found. In addition, the procedures were performed by four physicians showing no significant differences in technical success and symptoms reduction.

Conclusion

HRUS-CTR is a safe and effective method for the treatment of CTS, showing a statistically but mostly clinically significant reduction in symptom severity and hand discomfort, which persisted 1 year after release and should therefore be considered as an alternative approach to open or endoscopic CTR.

Zusammenfassung

Ziel

Bei schwerem oder therapierefraktärem Karpaltunnelsyndrom (CTS) wird die Spaltung des Ligamentum transversum carpi (CTR) offen chirurgisch, endoskopisch oder minimal-invasiv unter hochauflösender Ultraschallkontrolle (HRUS) durchgeführt. Diese Studie hatte zum Ziel, die langfristigen klinischen Ergebnisse nach HRUS-geführter CTR (HRUS-CTR) zu eruieren.

Material und Methode

Eine retrospektive Analyse wurde an 302 HRUS-CTR-Fällen durchgeführt. Patienten, die für ein telefonisches Interview verfügbar waren und eine Nachbeobachtungszeit von mindestens einem Jahr hatten, wurden mit dem Boston Carpal Tunnel Questionnaire (BCTQ) untersucht. Die Schwere der Symptome und funktionelle Einschränkungen wurden vor und nach dem Verfahren verglichen.

Ergebnisse

Von den 302 geprüften Fällen mussten 111 Fälle aufgrund der Nichtverfügbarkeit des Telefonanrufs, fehlender Daten oder des Todes ausgeschlossen werden. Dementsprechend wurden 191 Fälle aufgenommen. Das durchschnittliche Alter der Patienten betrug 60,4 ± 15,5 Jahre (19–87 Jahre). 126 Fälle (66%) waren weiblich und 65 Fälle (34,0%) männlich. Insgesamt gab es eine signifikante Reduktion von 91,9% der CTS-bedingten Symptomschwere und -häufigkeit für alle im Fragebogen erfassten Fragen. In ähnlicher Weise wurde eine signifikante Reduktion von 84,8% der Schwierigkeiten bei allen selbstberichteten täglichen Aktivitäten festgestellt. Zusätzlich wurden die Verfahren von vier Ärzten durchgeführt ohne Nachweis signifikanter Unterschiede im technischen Erfolg und in der Symptomreduktion.

Schlussfolgerungen

HRUS-CTR ist eine sichere und effektive Methode zur Behandlung von CTS mit einer statistisch, aber vor allem über einem Jahr anhaltenden klinisch signifikanten Reduktion der Symptomschwere und des Handunbehagens und sollte daher als alternativer Ansatz zur offen-chirurgischen oder endoskopischen CTR in Betracht gezogen werden.

Keywords

clinical outcomes - minimally invasive carpal tunnel release - carpal tunnel syndrome - ultrasound guidance

Publication History

Received: 03 June 2025

Accepted after revision: 07 August 2025

Accepted Manuscript online:
07 August 2025

Article published online:
08 September 2025

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