J Am Acad Orthop Surg Glob Res Rev. 2026 Sep 17;10(9):e26.00117. doi: 10.5435/JAAOSGlobal-D-26-00117. eCollection 2026 Sep 1.
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.
PMID:42757879 | PMC:PMC13593323 | DOI:10.5435/JAAOSGlobal-D-26-00117