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Tomasz Poboży

Ultrasound-guided carpal tunnel release: two-year randomized trial outcomes

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Tomasz Poboży

Polish version: Odbarczenie cieśni nadgarstka pod kontrolą USG — wyniki po 2 latach

Percutaneous ultrasound-guided carpal tunnel release produced improvement lasting at least 2 years, with its clearest advantage over mini-open release occurring early after treatment. Patients reported less incision-related pain, while both groups achieved clinically meaningful improvement in symptoms, pain and hand function.

Why this study matters

Carpal tunnel surgery aims to minimise tissue injury without compromising median nerve decompression. Continuous ultrasound allows real-time visualisation of the nerve, vessels, transverse carpal ligament and instrument, and the procedure can be performed in an office setting under local anaesthesia. The randomized trial by Smith and colleagues, published on 29 June 2026, addresses whether clinical improvement persists beyond the early period.

Study design

This prospective single-centre trial enrolled 41 beneficiaries of the US military healthcare system: 21 underwent office-based percutaneous ultrasound-guided release and 20 mini-open release. Mean age was 49.5 years; 58.5% were women and 41.5% were on active duty. Two-year data were available for every randomized and treated patient.

The primary endpoint was QuickDASH at 1 month. Pain, Boston Carpal Tunnel Questionnaire (BCTQ) symptom severity, incision-related palmar pain and adverse events were followed for 2 years.

Main results

At 1 month, mean QuickDASH changes were −8.2 points after ultrasound-guided release and −8.4 after mini-open surgery. BCTQ symptom severity changed by −0.9 and −1.2, respectively; numerical pain scores changed by −1.1 in both groups.

Ultrasound-guided release caused less incision-related pain during the first 4 weeks and less function-limiting pain during the first 3 weeks. Both groups maintained clinically meaningful symptom, pain and functional improvements through 2 years. One infection occurred in the ultrasound-guided group.

Clinical interpretation for an orthopaedic surgeon

The study does not demonstrate superior hand function at 2 years with ultrasound guidance. It suggests that a smaller access site may reduce early wound-related symptoms while maintaining durable clinical improvement. Office-based treatment may simplify the care pathway, but the trial did not assess whole-system costs or establish organisational advantages in every centre.

Limitations

  • Only 41 patients were enrolled, precluding reliable comparison of rare complications.
  • A single centre and a military healthcare population limit generalisability.
  • Assessment mainly used patient-reported outcomes; this was not a comprehensive study of costs, return to work or reoperation.
  • Results concern a specific percutaneous ultrasound-guided technique and do not apply automatically to every minimally invasive method.

Implications for practice

The findings support ultrasound-guided release as a technique with sustained clinical benefit, beyond a short-lived cosmetic advantage, and less early access-related pain. They do not establish greater overall efficacy than mini-open release or justify replacing conventional surgery for every patient. They also do not establish superiority in unusual anatomy, substantial structural abnormalities or cases requiring broader exploration.

References

  1. Domańska J, Poboży K, Domański P, Konarski W, Poboży T. Case Report: Diagnosis and Management of Carpal Tunnel Syndrome in a Patient With Oligodactyly. Issue Rehabil Orthop Neurophysiol Sport Promot. 2024;46(1):69–76. DOI: 10.19271/IRONS-000206-2024-46.
  2. Smith MS, Yuan X, Deal JB Jr, Nanos GP 3rd, Tintle SM, Hager NA, Reece DE, Miller ME. Carpal Tunnel Release Using Ultrasound Guidance: Two-Year Outcomes of a Randomized Controlled Trial Within the Military. J Hand Surg Glob Online. 2026;8(5):101078. DOI: 10.1016/j.jhsg.2026.101078. PMID 42404100.
  3. American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. 2024. AAOS Clinical Practice Guideline.

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Content prepared by: Tomasz Poboży - orthopaedic surgeon.

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