Journal of hand surgery global online · 2026
Propensity Score-Matched Comparison of Ultrasound-Guided Versus Open Carpal Tunnel Release: Three-Month Outcomes From the MISSION Registry.
СтатьяНазвание и аннотация: Перевод в очереди
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Marwin Victor M, Lincoski Christopher J, Nelson Johnny T, Watt James F, Moeller Amy T, Perry Paul E, Bontempo Nicholas A, Niedermeier Steven R, Miller Larry E, Moyles Kyle J
Аннотация
PURPOSE: The purpose of the study was to compare the safety and effectiveness of ultrasound-guided carpal tunnel release (UGCTR) and open carpal tunnel release (OCTR) in real-world clinical settings.
METHODS: Patients with carpal tunnel syndrome were prospectively enrolled in the multicenter MISSION registry and treated with unilateral UGCTR or OCTR by experienced surgeons. Outcomes included the Boston Carpal Tunnel Questionnaire Symptom Severity and Boston Carpal Tunnel Questionnaire Functional Status Scale, pain (0-10 scale), opioid use, health-related quality of life (EuroQoL 5-Dimension 5-Level), satisfaction (overall and wound), and adverse events through 3 months. Baseline group characteristics were balanced using propensity score matching.
RESULTS: A total of 178 patients per group were analyzed. The predominant anesthesia methods differed between groups (84.8% wide awake local anesthesia no tourniquet with UGCTR; 68.5% monitored anesthesia with OCTR). Ultrasound-guided carpal tunnel release was associated with shorter incisions (5.2 vs 16.5 mm) and less sutured wound closure (14.6% vs 100%), but longer procedure times (15 vs 6 minutes). At 3 months, UGCTR showed minor statistical advantages in Boston Carpal Tunnel Questionnaire Symptom Severity (group difference: -0.14 points), Boston Carpal Tunnel Questionnaire Functional Status Scale (group difference: -0.16 points), and pain severity (group difference: -0.6 points), with no statistical differences in EuroQoL 5-Dimension 5-Level (group difference: 0.03 points) or overall satisfaction (group difference: 4.9%). Opioid use was less common (10.2% vs 49.1%), wound satisfaction was higher (94.2% vs 84.0%), and wound symptoms were less severe after UGCTR (60.7% vs 22.8% with no sensitivity or pain). Nonserious adverse event rates were comparable (1.1% vs 0.0%).
CONCLUSIONS: Ultrasound-guided CTR and OCTR provided safe and effective symptom relief in routine clinical practice. Ultrasound-guided CTR was associated with less anesthesia, shorter incisions, reduced opioid use, and fewer wound symptoms, whereas procedure time was shorter with OCTR. Technique selection should be guided by shared decision making, considering patient expectations and surgeon's judgment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
METHODS: Patients with carpal tunnel syndrome were prospectively enrolled in the multicenter MISSION registry and treated with unilateral UGCTR or OCTR by experienced surgeons. Outcomes included the Boston Carpal Tunnel Questionnaire Symptom Severity and Boston Carpal Tunnel Questionnaire Functional Status Scale, pain (0-10 scale), opioid use, health-related quality of life (EuroQoL 5-Dimension 5-Level), satisfaction (overall and wound), and adverse events through 3 months. Baseline group characteristics were balanced using propensity score matching.
RESULTS: A total of 178 patients per group were analyzed. The predominant anesthesia methods differed between groups (84.8% wide awake local anesthesia no tourniquet with UGCTR; 68.5% monitored anesthesia with OCTR). Ultrasound-guided carpal tunnel release was associated with shorter incisions (5.2 vs 16.5 mm) and less sutured wound closure (14.6% vs 100%), but longer procedure times (15 vs 6 minutes). At 3 months, UGCTR showed minor statistical advantages in Boston Carpal Tunnel Questionnaire Symptom Severity (group difference: -0.14 points), Boston Carpal Tunnel Questionnaire Functional Status Scale (group difference: -0.16 points), and pain severity (group difference: -0.6 points), with no statistical differences in EuroQoL 5-Dimension 5-Level (group difference: 0.03 points) or overall satisfaction (group difference: 4.9%). Opioid use was less common (10.2% vs 49.1%), wound satisfaction was higher (94.2% vs 84.0%), and wound symptoms were less severe after UGCTR (60.7% vs 22.8% with no sensitivity or pain). Nonserious adverse event rates were comparable (1.1% vs 0.0%).
CONCLUSIONS: Ultrasound-guided CTR and OCTR provided safe and effective symptom relief in routine clinical practice. Ultrasound-guided CTR was associated with less anesthesia, shorter incisions, reduced opioid use, and fewer wound symptoms, whereas procedure time was shorter with OCTR. Technique selection should be guided by shared decision making, considering patient expectations and surgeon's judgment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.