European radiology · 2026
Ultrasound-guided versus landmark-guided corticosteroid injections for carpal tunnel syndrome: an overview and cross-sectional analysis of overlapping meta-analyses of randomized controlled trials.
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Zhang Shunxin, Du Ying, Wen Tianlin, Gu Peng, Jia Zhiwei, Li Wei
Аннотация
OBJECTIVES: The efficacy of ultrasound-guided (USG) versus landmark-guided (LMG) corticosteroid injections for carpal tunnel syndrome (CTS) is debated, with existing meta-analyses offering conflicting conclusions. This study aimed to conduct an overview and cross-sectional analysis of overlapping meta-analyses to provide robust clinical guidance for USG and LMG injections in CTS.
MATERIALS AND METHODS: We searched for meta-analyses of randomized controlled trials (RCTs) comparing USG and LMG corticosteroid injections for CTS. Methodological quality was assessed using Oxford Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Data extraction and quality appraisal were performed independently by two reviewers. The Jadad decision algorithm identified the highest-quality meta-analysis.
RESULTS: Seven meta-analyses were included in this study, all categorized as Level-II evidence, with AMSTAR scores from 7 to 10 (median 8). The Jadad decision algorithm facilitated the selection of a methodologically robust meta-analysis. It revealed that USG injections resulted in significantly better Boston Carpal Tunnel Questionnaire functional status scale and symptom severity scale outcomes, together with a lower adverse event rate compared with LMG injections. The selected meta-analysis revealed no significant disparities when evaluating overall grip strength and electrophysiological findings, including compound muscle action potential, sensory nerve action potential, distal motor latency, and distal sensory latency.
CONCLUSIONS: The highest-quality evidence indicates that USG injections provide significant advantages over LMG injections in improving functional outcomes, reducing symptom severity, and lowering adverse event rates. Nevertheless, further high-quality trials with longer follow-up are needed to confirm the durability of these benefits.
KEY POINTS: Question What is the comparative effectiveness and safety of ultrasound-guided versus landmark-guided corticosteroid injections for carpal tunnel syndrome amid conflicting meta-analytic evidence? Findings Ultrasound-guided corticosteroid injections were associated with better patient-reported outcomes and fewer adverse events, while no included meta-analysis favored landmark-guided corticosteroid injections. Clinical relevance Ultrasound-guided corticosteroid injections may improve patient-reported outcomes and reduce adverse events, supporting their preferential use when expertise and resources are available.
MATERIALS AND METHODS: We searched for meta-analyses of randomized controlled trials (RCTs) comparing USG and LMG corticosteroid injections for CTS. Methodological quality was assessed using Oxford Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Data extraction and quality appraisal were performed independently by two reviewers. The Jadad decision algorithm identified the highest-quality meta-analysis.
RESULTS: Seven meta-analyses were included in this study, all categorized as Level-II evidence, with AMSTAR scores from 7 to 10 (median 8). The Jadad decision algorithm facilitated the selection of a methodologically robust meta-analysis. It revealed that USG injections resulted in significantly better Boston Carpal Tunnel Questionnaire functional status scale and symptom severity scale outcomes, together with a lower adverse event rate compared with LMG injections. The selected meta-analysis revealed no significant disparities when evaluating overall grip strength and electrophysiological findings, including compound muscle action potential, sensory nerve action potential, distal motor latency, and distal sensory latency.
CONCLUSIONS: The highest-quality evidence indicates that USG injections provide significant advantages over LMG injections in improving functional outcomes, reducing symptom severity, and lowering adverse event rates. Nevertheless, further high-quality trials with longer follow-up are needed to confirm the durability of these benefits.
KEY POINTS: Question What is the comparative effectiveness and safety of ultrasound-guided versus landmark-guided corticosteroid injections for carpal tunnel syndrome amid conflicting meta-analytic evidence? Findings Ultrasound-guided corticosteroid injections were associated with better patient-reported outcomes and fewer adverse events, while no included meta-analysis favored landmark-guided corticosteroid injections. Clinical relevance Ultrasound-guided corticosteroid injections may improve patient-reported outcomes and reduce adverse events, supporting their preferential use when expertise and resources are available.