Victor M. Marwin<\/b><\/strong><\/p>\n<\/div>\n \u201cThe key takeaways were 84.8% of the ultrasound-guided carpal tunnel release surgeries were done with just local anesthesia compared with 19.1% for open carpal tunnel patients,\u201d Marwin said.<\/p>\n
Marwin also said patients who received ultrasound-guided carpal tunnel release had a shorter incision (5.2 mm vs. 16.5 mm) and rarely required suture closure based on surgeon preference (14.6% vs. 100%). However, ultrasound-guided carpal tunnel release yielded a longer procedure time. Only 10.2% of patients in the ultrasound-guided carpal tunnel release group used opioids vs. 49.1% of patients in the open carpal tunnel release group, according to Marwin.<\/p>\n
\u201cImprovements in symptom severity and functional status favored the ultrasound group, although there were improvements in both groups,\u201d Marwin said.<\/p>\n
In addition, he said patients in the ultrasound-guided carpal tunnel release group had better symptom resolution, with a complete resolution of sensitivity and pain reported in 60.7% of patients vs. 22.8% of patients in the open carpal tunnel release group.<\/p>\n
According to Marwin, these results \u201chighlight the ability to do a minimally invasive surgery without the use of a tourniquet, wide-awake with local anesthesia only in an office-based setting\u201d and \u201csets the standard for the future of carpal tunnel release surgery.\u201d Marwin said the addition of a new CPT code for ultrasound-guided carpal tunnel release that was announced this year helps pave the way to perform this procedure in an office, a stand-alone ASC or a hospital setting.<\/p>\n
\u201cSurgeons certainly have their choice of which environment to perform this in, and it is my hope they take full advantage of this technique and end up transitioning to the office where patients prefer to have this procedure,\u201d Marwin said.<\/p>\n
For more information:<\/h2>\n Victor M. Marwin, MD, MBA,<\/b> wishes to be contacted at victor.marwin@bluegrassortho.com.<\/p>\n\n
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Perspective<\/h2>\n Back to Top
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Victor M. Marwin, MD, MBA, and colleagues present a comparative analysis of patients having undergone either an ultrasound-guided carpal tunnel release or an open carpal tunnel release by analyzing patients from the MISSION registry \u2014 a carpal tunnel release registry initiated in 2024. Like past studies comparing ultrasound-guided vs. open carpal tunnel release, the results identified comparable clinical outcomes, less anesthesia, longer procedure times but no need for an OR, and less surgical complications with ultrasound-guided carpal tunnel release.<\/p>\n
I would consider these findings credible as ultrasound-guided carpal tunnel release can be done under local anesthetic in an office setting with a smaller surgical footprint. As such, the validity of ultrasound-guided carpal tunnel release is not in question. However, the two ongoing concerns to consider with the ultrasound-guided carpal tunnel release technique relative to the traditional open carpal tunnel release is the learning curve with the use of an ultrasound and the potential for nonsurgeons performing carpal tunnel procedures. Learning to use an ultrasound requires active education by the surgeon as ultrasound has not traditionally been taught in surgical training. But performing ultrasound-guided carpal tunnel release by nonsurgeons creates a dilemma that can both compromise broader surgical volume while exposing patients to risk by technicians who do not have the surgical ability to convert to open if necessary nor the surgical experience to avoid or manage procedural complications.<\/p>\n
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Asif M. Ilyas, MD, MBA, FACS<\/strong><\/p>\n\nProgram director emeritus of hand surgery fellowship<\/li>\n Rothman Orthopaedics<\/li>\n President of the Rothman Institute Foundation for Opioid Research & Education Foundation<\/li>\n Professor of orthopedic surgery<\/li>\n Sidney Kimmel Medical College at Jefferson<\/li>\n Medical director at Orthopaedic Surgery Center at Bryn Mawr Hospital<\/li>\n Bryn Mawr, Pennsylvania<\/li>\n<\/ul><\/div>\n
Disclosures: <\/strong> Ilyas reports being a consultant for Arthrex, Axogen, Globus and Stryker, as well as being an executive with Walant Surgical Solutions Inc.
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