Effect of Ultrasound-Guided Partial Release of the Transverse Carpal Ligament with a Needle in Patients with Refractory Carpal Tunnel Syndrome.

BACKGROUND

Neuropathic pain in the hands due to carpal tunnel syndrome (CTS) disturbs sleep and affects the quality of life.

OBJECTIVES

We evaluated the effect of ultrasound (US)-guided partial release of the transverse carpal ligament (TCL) using an 18-G needle in patients with refractory CTS.

STUDY DESIGN

A prospective outcome study.

SETTING

The outpatient clinic of a single academic medical center.

METHODS

This study was prospectively conducted. A total of 155 consecutive patients (191 wrists) with refractory chronic CTS (M:F = 28:127; age = 54.7 ± 9.6 years; pain duration = 50.3 ± 36.3 weeks) were enrolled and underwent US-guided partial release of the TCL using a needle. The pain severity was measured using the Numeric Rating Scale (NRS) at 3 and 6 months after the treatment. Successful treatment outcomes were defined as more than 50% reduction in the NRS score at 6 months after the treatment compared with the score at pre-treatment and NRS score < 3 at 6 months after the treatment without any surgical intervention.

RESULTS

There were 3 dropouts, and 188 wrists were included in the study. No side effects were reported. A total of 162 wrists (86.2%) showed successful treatment outcomes at 6 months after TCL release. Of the 26 wrists which had unsuccessful treatment outcomes, 6 received surgical treatment. The NRS scores at 3- and 6-month post-treatment were significantly reduced: the average NRS scores were 7.1 ± 0.6 at baseline, 1.9 ± 1.7 at 3 months after the treatment, and 1.7 ± 1.7 at 6 months after the treatment.

LIMITATIONS

We conducted our study without a control or a placebo group.

CONCLUSION

We believe that US-guided partial release of the TCL using a needle can be an effective and safe technique for treating chronic refractory pain due to CTS. It can potentially be attempted before surgical treatment.