Journal CME, March 2023: Ultrasound-guided percutaneous carpal tunnel release: A systematic review-Journal CME, March 2023: Ultrasound-guided percutaneous carpal tunnel release: A systematic review

Journal CME, March 2023: Ultrasound-guided percutaneous carpal tunnel release: A systematic review

Pdf Summary

The systematic review by Chou et al. focuses on evaluating the clinical effectiveness and safety of ultrasound-guided percutaneous carpal tunnel release (USCTR) for treating carpal tunnel syndrome (CTS). This review encompasses 20 studies including randomized controlled trials (RCTs), prospective cohort studies, and case series, covering a total of 1772 cases.<br /><br />Key findings from the review are:<br />- USCTR shows potential as an effective treatment for CTS, indicated by significant improvements in functional outcomes measured by the Boston Carpal Tunnel Questionnaire (BCTQ) and Quick Disabilities of Arm, Shoulder & Hand (QDASH).<br />- The level of evidence overall is very low, with most studies having at least moderate risk of bias.<br />- Despite the low evidence, some studies suggest that USCTR can provide faster return-to-work times compared to traditional open or mini-open carpal tunnel releases.<br />- Complications were minimal with one major complication (compartment syndrome) and 24 minor complications recorded in the reviewed studies. Most complications were self-limited and did not result in permanent issues.<br /><br />Procedural comparisons found no significant differences in functional outcomes between USCTR and traditional methods such as open carpal tunnel release (OCTR) or mini-open releases. However, USCTR might offer advantages in terms of less postoperative pain, shorter recovery times, and the viability of simultaneous bilateral carpal tunnel releases, especially beneficial for individuals relying heavily on their hands, like wheelchair users.<br /><br />The procedures were primarily performed under local anesthesia in an outpatient setting, with tools like hook knives, needles, and looped threads varying across studies. Data show that specialized training in musculoskeletal ultrasound is crucial for procedural efficacy and safety.<br /><br />While USCTR shows promise, the necessity for high-quality, head-to-head studies with the current standard-of-care surgical techniques remains to better validate these findings. The review concludes that USCTR has the potential to be an effective alternative with specific advantages, but further evidence is essential for comprehensive validation.

Keywords

ultrasound-guided percutaneous carpal tunnel release

USCTR

carpal tunnel syndrome

CTS

clinical effectiveness

safety

Boston Carpal Tunnel Questionnaire

Quick Disabilities of Arm Shoulder & Hand

randomized controlled trials

complications