Prospective Multicenter Propensity Score-matched Comparison of Ultrasound-guided Versus Endoscopic Carpal Tunnel Release

Purpose: To compare 3-month clinical outcomes of patients treated with ultrasound-guided carpal tunnel release (UGCTR) or endoscopic carpal tunnel release (ECTR) in routine clinical practice. Methods: This prospective multicenter observational study enrolled patients with carpal tunnel syndrome who were treated with UGCTR or ECTR by experienced surgeons. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale and Functional Status Scale, pain severity (0-10 scale), opioid use, health-related quality of life, overall satisfaction, wound satisfaction, and adverse events through 3 months. Propensity score matching was performed to balance patient characteristics between groups. Results: Among 372 matched patients (186 per group), UGCTR was more commonly performed under wide-awake local anesthesia with no tourniquet (85.5% vs 30.1%), had a shorter incision length (5 vs 12 mm), and required less frequent suture closure (11.0% vs 100%). In contrast, procedure time was shorter with ECTR (8 vs 17 minutes). At 3 months, both groups showed significant improvement, with minor differences statistically favoring UGCTR (Boston Carpal Tunnel Questionnaire Symptom Severity Scale, 0.13 points; Functional Status Scale, 0.19 points; pain severity, 0.6 points; health-related quality of life, 0.05 points). Opioid use was lower after UGCTR (10.3% vs 39.7%). Overall satisfaction (92.1% vs 83.6%) and wound satisfaction (93.9% vs 88.3%) were higher with UGCTR. No serious adverse events occurred; nonserious events were less frequent with UGCTR (0% vs 5.9%). Conclusions: UGCTR and ECTR are safe and effective treatments for carpal tunnel syndrome. UGCTR was more commonly performed under wide-awake local anesthesia with no tourniquet and was associated with reduced opioid use and higher overall/wound satisfaction, whereas ECTR was associated with a shorter procedure time. Type of study/level of evidence: Therapeutic II.