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Ultrasound-Guided Percutaneous Carpal Tunnel Release for Treatment of Carpal Tunnel Syndrome

January 17, 2019

Health Problem: Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist. It is characterized by increased pressure within the carpal tunnel and decreased function of the nerve. The estimated prevalence of CTS is 3.1% to 7.8% among adult workers, with higher prevalence among female and older-age workers.

Technology Description: Surgery for CTS is referred to as carpal tunnel release, which involves decompression of the carpal tunnel by cutting through the ligament pressing down on the carpal tunnel. This report focuses on percutaneous carpal tunnel release (PCTR) for CTS. PCTR combines ultrasound guidance with minimal incisions. Other approaches to carpal tunnel release are conventional open CTR (OCTR), mini-OCTR, or endoscopic CTR.

Controversy: OCTR is the current standard for surgical treatment for CTS. Endoscopic techniques have been suggested to reduce postoperative pain and return to work, as well as to allow for faster recovery of function. However, endoscopy has been criticized due to its learning curve, expensive equipment, and the potential risk of injury to neurovascular structures. PCTR combines inexpensive ultrasound equipment with minimally invasive incisions; however, the safety and effectiveness of PCTR needs to be established.

Key Questions:

  • Is PCTR effective in treating CTS in adults?
  • What complications are associated with PCTR?
  • Have definitive patient selection criteria been established for PCTR in adults?