Related Experiment Video
Updated: Sep 19, 2026
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Percutaneous Ultrasonography-guided Release of the Transverse Carpal Ligament versus Open Surgery for Carpal Tunnel
Manuel Castro-Menéndez1, Patricia Balvís-Balvís, Elena Perez-Alfonso
1From the Department of Orthopedics and Traumatology. University Hospital Complex of Vigo (Dr. Castro-Menéndez, Dr. Balvís-Balvís, Dr. Perez-Alfonso, Dr. Oiartzabal, Dr. Cela-Lopez), Vigo, Spain, and the Department of Orthopedics and Traumatology, University Hospital Complex of Ourense (Dr. Dominguez Prado), Ourense, Spain.
Purpose:
To compare clinical outcomes between ultrasonography-guided percutaneous and open transverse carpal ligament (TCL) release for carpal tunnel syndrome at short-term follow-up.
Methods:
A prospective cohort study was conducted in 200 patients with CTS (100 per group) treated with either ultrasonography-guided percutaneous or open TCL release. Boston Carpal Tunnel Questionnaire (BCTQ) scores, grip strength (JAMAR dynamometer), postoperative symptoms, complications, and satisfaction were evaluated preoperatively, at 6 weeks, and at 3 months. Minimal clinically important difference (MCID) was assessed. A Joinpoint model analyzed the effect of requiring technically demanding skills for the percutaneous group.
Results:
Both groups showed significant improvement in BCTQ scores (P < 0.001). The percutaneous group, despite worse preoperative scores, demonstrated significantly greater improvement in total BCTQ and its subscales (P < 0.001), even after relative MCID adjustment. Grip strength recovery was superior in the percutaneous group at 3 months (P < 0.001). Postoperative scar tenderness, pillar pain, and residual paresthesias were significantly less frequent in this group (P < 0.05). Complication rates were low and comparable. One case of transient neuritis occurred in the percutaneous group. Patient satisfaction exceeded 97% in both groups.
Conclusion:
Ultrasonography-guided percutaneous flexor retinaculum release offers superior early clinical outcomes and faster functional recovery compared with open surgery, with a comparable safety profile. These findings support its adoption in experienced hand surgery centers with ultrasonography capabilities.
