Percutaneous Ultrasonography-guided Release of the Transverse Carpal Ligament versus Open Surgery for Carpal Tunnel Syndrome: A Prospective Comparative Study

Abstract

Purpose: To compare clinical outcomes between ultrasonography-guided percutaneous and open transverse carpal ligament (TCL) release for carpal tunnel syndrome at short-term follow-up. Methods: A prospective cohort study was conducted in 200 patients with CTS (100 per group) treated with either ultrasonography-guided percutaneous or open TCL release. Boston Carpal Tunnel Questionnaire (BCTQ) scores, grip strength (JAMAR dynamometer), postoperative symptoms, complications, and satisfaction were evaluated preoperatively, at 6 weeks, and at 3 months. Minimal clinically important difference (MCID) was assessed. A Joinpoint model analyzed the effect of requiring technically demanding skills for the percutaneous group. Results: Both groups showed significant improvement in BCTQ scores (P < 0.001). The percutaneous group, despite worse preoperative scores, demonstrated significantly greater improvement in total BCTQ and its subscales (P < 0.001), even after relative MCID adjustment. Grip strength recovery was superior in the percutaneous group at 3 months (P < 0.001). Postoperative scar tenderness, pillar pain, and residual paresthesias were significantly less frequent in this group (P < 0.05). Complication rates were low and comparable. One case of transient neuritis occurred in the percutaneous group. Patient satisfaction exceeded 97% in both groups. Conclusion: Ultrasonography-guided percutaneous flexor retinaculum release offers superior early clinical outcomes and faster functional recovery compared with open surgery, with a comparable safety profile. These findings support its adoption in experienced hand surgery centers with ultrasonography capabilities.