1. 2022;25;E141-E145Effect of Ultrasound-Guided Partial Release of the Transverse Carpal Ligament with a Needle in Patients with Refractory Carpal Tunnel Syndrome
   Prospective Study
   Min Cheol Chang, MD, Hyun Hee Choi, MS, and Sang Hoon Lee, MD.

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.

KEY WORDS: Ultrasound, release, carpal tunnel syndrome, needle, chronic pain, transverse carpal ligament