Ultra-Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: A Randomized Clinical Trial.
OBJECTIVE
The purpose of this study was to compare the outcomes of 1-mm ultra-minimally invasive ultrasound-guided carpal tunnel release and 2-cm blind mini-open carpal tunnel release.


METHODS
We conducted a single-center individual parallel-group controlled-superiority randomized control trial in an ambulatory office-based setting at a third-level referral hospital. Eligible participants had clinical signs of primary carpal tunnel syndrome and positive electrodiagnostic test results and were followed for 12 months. Independent outcome assessors were blinded. Patients were randomized by concealed allocation (1:1) by an independent blocked computer-generated list. The postoperative score on the Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was the primary variable. Grip strength and time for discontinuation of oral analgesics, complete wrist flexion-extension, relief of paresthesia, and return to normal daily activities (including work) were assessed.


RESULTS
Ninety-two of 128 eligible patients were randomly allocated and analyzed. QuickDASH scores were 2.2 to 3.3 times significantly lower in the ultra-minimally invasive group for the first 6 months: 23.6 [95% confidence interval (CI), 20.5, 27.4] versus 52.6 [95% CI, 49.4, 57.0] at the first week and 4.09 [95% CI, 1.5, 7.1] versus 13.0 [95% CI, 9.4, 18.9] at 6 months. Return to normal daily activities occurred significantly sooner in the ultra-minimally invasive group: 4.9 [95% CI, 3.2, 6.5] versus 25.4 [95% CI, 18.2, 32.6] days.


CONCLUSIONS
Ultra-minimally invasive carpal tunnel release provides earlier functional return and less postoperative morbidity with the same neurologic recovery as mini-open carpal tunnel release for patients with symptomatic primary carpal tunnel syndrome.
Unit of Hand Surgery, Department of Orthopedics, MedCare Orthopedics and Spine Hospital. Dubai, United Arab Emirates k2rojo@yahoo.com.
Jose Manuel
JM
Rojo-Manaute
Department of Physical and Rehabilitation Medicine, University Hospital La Paz, Madrid, Spain.
Alberto
A
Capa-Grasa
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Francisco
F
Chana-Rodríguez
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Ruben
R
Perez-Mañanes
Department of Physical and Rehabilitation Medicine, Hospital Nuestra Señora de America, Madrid, Spain.
Guillermo
G
Rodriguez-Maruri
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Pablo
P
Sanz-Ruiz
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Jorge
J
Muñoz-Ledesma
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Mikel
M
Aburto-Bernardo
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Luis
L
Esparragoza-Cabrera
Unit of Hand Surgery, Hospital Beata María Ana, Madrid, Spain.
Miguel Del
MD
Cerro-Gutiérrez
Department of Orthopedic Surgery, University Hospital Gregorio Marañón, Madrid, Spain.
Javier
J
Vaquero-Martín
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
carpal tunnel; minimally invasive; musculoskeletal ultrasound; ultrasound; ultrasound-guided