ABSTRACT
Purpose: The purpose of this study was to determine the safety and effectiveness of office-based carpal tunnel release with ultrasound guidance (CTR-US). Methods: In this prospective multicenter observational study, patients were treated with CTR-US in an office setting. Outcomes were time to resume normal daily activities, time to return to work, Boston Carpal Tunnel Questionnaire Symptom Severity Scale and Functional Status Scale scores, Michigan Hand Questionnaire, Numeric Pain Scale, EuroQoL-5 Dimension 5-Level score, procedure satisfaction, and adverse events over 6 months. Results: A total of 149 participants (226 hands) from seven centers underwent office-based CTR-US. The mean age was 58 years, 52% were women, and 68% were employed. The mean incision length was 5 mm, 52% had simultaneous bilateral procedures, and wide-awake local anesthesia no tourniquet was used in all cases. All procedures were completed as planned, with no conversions to open repair and mean intraoperative pain severity of 1.6 ± 1.5. The median time to resume normal activities was 2 days (interquartile range: 1-4 days) and return to work was 4 days (interquartile range: 1-5 days). Over 6 months, Boston Carpal Tunnel Questionnaire Symptom Severity Scale decreased by a mean of 1.7 points, Boston Carpal Tunnel Questionnaire Functional Status Scale decreased by 1.1 points, Michigan Hand Questionnaire Global score increased by 35 points, Numeric Pain Scale decreased by 3.7 points, and EuroQoL-5 Dimension 5-Level score increased by 0.11 points. At 6 months, 94% reported procedure satisfaction. Unilateral and simultaneous bilateral procedures were similarly effective. There was one (0.4%) adverse event, a nerve contusion treated with neurolysis and nerve wrap where the patient fully regained normal function within 7 weeks. There were no revisions for persistent or recurrent carpal tunnel syndrome symptoms. Conclusions: Office-based CTR-US, performed either unilaterally or as simultaneous bilateral procedures, is well tolerated with a low complication rate and associated with rapid recovery, sustained improvement in symptoms and function, and high procedure satisfaction. Type of study/level of evidence: Therapeutic III.
ABSTRACT
Background: The duration of postoperative leave varies by the carpal tunnel release (CTR) technique. This study aimed to determine the time to return to work (RTW) after CTR with ultrasound (CTR-US) guidance and identify factors contributing to this duration. Methods: This was a multicenter postmarket registry of patients treated with CTR-US. Time to RTW was analyzed with Kaplan-Meier methods. Logistic regression identified the association of patient, work, and procedural factors with the probability of RTW within 5 days (a standard work week) after CTR-US. Results: A total of 544 employed patients (655 hands) from 24 centers were treated with CTR-US between November 2019 and August 2022. The mean patient age was 50 years, 62% were women, and most (76%) were full-time employees, where work activities were desk-based (49%), light manual (28%), or heavy manual (23%). The complication rate was 0.8%. After CTR-US, the median RTW was 3 days (interquartile range: 1-6 days), with 74.6% returning by 5 days, 87.8% by 10 days, and 97.1% by 30 days. Work activity (desk-based versus heavy manual: odds ratio = 2.93, 95% confidence interval: 1.70-5.04, P < 0.001) and sex (man versus woman: odds ratio = 1.85, 95% confidence interval: 1.15-2.98, P = 0.01) were associated with higher probability of RTW within 5 days. The median RTW ranged from 2 to 4 days in all patient subgroups, including heavy manual laborers (median 4 days) and women (median 3 days). Conclusions: CTR-US offers an efficient approach to treating CTS, enabling most patients to RTW with minimal delay. The short recovery periods observed across diverse patient and work characteristic subgroups compare favorably to other CTR techniques.
