Efficacy and Safety of Ultrasound-Guided Carpal Tunnel Release: A Systematic Review and Meta-Analysis

Carpal tunnel syndrome is the most common upper extremity compression neuropathy, often requiring surgical intervention. Although open carpal tunnel release is effective, it has been associated with greater scarring and morbidity. Ultrasound-guided carpal tunnel release (USCTR) has emerged as a minimally invasive alternative. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of USCTR compared with open techniques.

PubMed, Embase, ScienceDirect, and the CENTRAL databases were searched for studies describing USCTR with complete transverse carpal ligament release. Risk of bias was performed using the Cochrane risk-of-bias, Newcastle Ottawa, and Joanna Briggs Institute tools. Extracted data included patient demographics, functional outcomes, advanced imaging and nerve conduction metrics, patient-reported outcomes, and complications or reoperations. Meta-analyses were conducted on studies comparing USCTR with open techniques.

Forty-three articles were included in this study, with 4097 patients. USCTR demonstrated significant improvements in functional outcomes, nerve conduction metrics, and patient-reported outcomes, exceeding minimal clinically important differences. Meta-analyses revealed no differences in motor latency, sensory conduction velocity, or complication rates between USCTR and open techniques. USCTR patients returned to work 10.15 days earlier ( P = 0.02) and resumed normal activities 21 days earlier ( P < 0.001) compared with open techniques. Complication and reoperation rates for USCTR were 1.57% and 0.34%, respectively.

USCTR is a safe and effective alternative to open techniques, offering comparable outcomes with shorter recovery times and earlier return to work. Large-scale prospective studies should further evaluate its role in the treatment of carpal tunnel syndrome.