Background: Carpal tunnel syndrome (CTS) is the most common cause of upper limb entrapment neuropathy. Transverse carpal ligament release is a definitive treatment for advanced stage of disease. However, the evidence to support ultrasonographic guidance of this procedure is scarce.

Objective: To evaluate the results of ultrasound-guided percutaneous carpal tunnel release (USG-PCTR) with hook blade, specifically on median nerve anatomical and physiological improvements, symptom relief, functional recovery, complications, and satisfaction outcomes.

Materials and Methods: The present study was single center, prospective cohort study. Patients diagnosed as moderate to severe degree CTS with electrodiagnostic confirmation, symptoms persisting more than six months and unresponsive to conservative treatment were enrolled. Patients with rheumatoid arthritis, previous CTR, pregnancy, bleeding risks, and space occupying lesion were excluded. The procedure was an USG-PCTR with hook blade. Boston Carpal Tunnel Questionnaire (BCTQ), median nerve cross-sectional area (CSA) at distal wrist crease, proximal and distal carpal tunnel, median nerve conduction studies including distal sensory latency (DSL), distal motor latency (DML), and compound motor action potential (CMAP) amplitude, and surgical complications were collected at three- and six-months follow-up.

Results: Nineteen wrists from 16 patients received USG-PCTR with hook blade were included in the present analyses. All outcome measurements (BCTQ, median nerve CSA and median nerve conduction studies) were significantly improved at three- and six-months follow-up compared to pre-treatment. Mean subject satisfaction scores was 9.68. Only five patients (26.31%) had a transient paresthesia, and no severe complication was observed.

Conclusion: USG-PCTR with hook blade was an effective treatment for advanced idiopathic CTS in terms of median nerve anatomy and physiology. The results showed significant improvement of patient’s symptom and function with high-level of satisfaction and no major complications.

Keywords: Carpal tunnel release, Percutaneous, Ultrasound-guided