Safety and effectiveness of ultrasound-guided versus open carpal tunnel release: a systematic review and meta-analysis of prospective controlled studies.

BACKGROUND: This systematic review and meta-analysis compared the safety and effectiveness of ultrasound-guided carpal tunnel release (UGCTR) and open carpal tunnel release (OCTR). METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for prospective studies comparing blade-based UGCTR and OCTR. Random-effects meta-analysis compared time to return to normal activities; Boston Carpal Tunnel Questionnaire Symptom Severity (BCTQ-SSS) and Functional Status (BCTQ-FSS) scores, pain severity, and patient satisfaction at 3 and 12 months; and complications through 12 months. RESULTS: Six studies (four randomized; 749 patients) were included. UGCTR was associated with earlier return to normal activities than OCTR (mean difference: -13.9 days; 95% CI: -27.5 to -0.3; p = 0.045), although this estimate was sensitive to removal of individual studies. No significant group differences were observed in BCTQ scores, pain severity, or patient satisfaction at 3 or 12 months, and heterogeneity was considerable for most outcomes. Complication rates did not significantly differ (4.4% vs. 4.1%; risk ratio: 1.11; 95% CI: 0.55 to 2.25; p = 0.77). CONCLUSIONS: Compared with OCTR, UGCTR was associated with earlier return to normal activities, with no significant group differences in other outcomes. The findings are limited by considerable heterogeneity and few eligible studies.