Comparison efficacy of ultrasound-guided needle release plus corticosteroid injection and mini-open surgery in patients with carpal tunnel syndrome

Abstract

This retrospective study was to compare clinical outcomes of ultrasound-guided needle release with corticosteroid injection vs. mini-open surgery in patients with carpal tunnel syndrome (CTS). From January 2021 to December 2021, 40 patients (40 wrists) with CTS were analyzed in this study. The diagnosis was based on clinical symptoms, electrophysiological imaging, and ultrasound imaging. A total of 20 wrists were treated with ultrasound-guided needle release plus corticosteroid injection (Group A), and the other 20 wrists were treated with mini-open surgery (Group B). We evaluated the Boston carpal tunnel questionnaire, electrophysiological parameters (distal motor latency, sensory conduction velocity, and sensory nerve action potential of the median nerve), and ultrasound parameters (cross-sectional area, flattening ratio, and the thicknesses of transverse carpal ligament) both before and 3 months after treatment. Total treatment cost, duration of treatment, healing time, and complications were also recorded for the two groups. The Boston carpal tunnel questionnaire and electrophysiological and ultrasound outcomes at preoperatively and 3 months postoperatively had a significant difference for each group (each with P < 0.05). There were no complications such as infection, hemorrhage, vascular, nerve, or tendon injuries in both groups. Ultrasound-guided needle release and mini-open surgery are both effective measures in treating CTS patients. Ultrasound-guided needle release plus corticosteroid injection provides smaller incision, less cost, less time of treatment, and faster recovery compared with mini-open surgery. Ultrasound-guided needle release plus corticosteroid injection is better for clinical application.

Keywords: carpal tunnel syndrome; mini-open surgery; needle release; transverse carpal ligament; ultrasound.

Figure 1

Ultrasound-guided needle release plus corticosteroid injection procedure of a Group A patient. (a) The transverse carpal ligament (TCL) was compressed (white arrow) in the ultrasound image before treatment. (b) Acupuncture process (c) 2 ml mixture solution (white ellipse) which contained 1 ml of 2% lidocaine and 1 ml of betamethasone were injected into the carpal tunnel. (d) TCL was normal (no compression) after 3-month follow-up in the ultrasound image. (e) Sonographer held the probe covered with surgical gloves with one hand and acupuncture compression of the TCL at the median nerve continuously under the continuous guidance of ultrasound. (f) Postoperative image (no scar).

Figure 2

Mini-open surgery of a Group B patient. (a) The transverse carpal ligament (TCL) was compressed (white arrow) in the ultrasound image before treatment. (b) TCL was normal (no compression) after 3-month follow-up in the ultrasound image. (c) Postoperative image (with a 2-cm scar).