Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

King Hei Stanley Lam, Yung-Tsan Wu, Kenneth Dean Reeves, Felice Galluccio, Abdallah El-Sayed Allam, Philip W H Peng, King Hei Stanley Lam, Yung-Tsan Wu, Kenneth Dean Reeves, Felice Galluccio, Abdallah El-Sayed Allam, Philip W H Peng

Abstract

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.

Keywords: carpal tunnel syndrome; injection; intervention; release; ultrasound-guided.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 2
Figure 2
Meta—analysis of UPIT with steroids vs. landmark-guided steroid injection. US, ultrasound; LM, landmark; VAS, visual analogue scale; BCTQ—SS, Boston Carpal Tunnel Questionnaire—symptom scale; BCTQ—FS, Boston Carpal Tunnel Questionnaire—functional scale. The green squares represent the differences between the means of each of the two groups compared, i.e., the mean differences. The size of the green square represents how much that individual study affects the overall outcome of the meta—analysis, i.e., the weight of the studies on the meta—analysis. The precision of the study depends on the 95% confidence interval for that mean difference, i.e., the length of the straight lines, the shorter the lines, the more precise the mean differences. The black trapezoid is the pooled mean difference of all the studies combined in consideration of the weight of each study, with its confidence interval extending from the left tip to the right tip.
Figure 3
Figure 3
Meta—analysis of UPIT with high—dose vs. low—dose steroids. VAS, visual analogue scale; BCTQ—SS, Boston Carpal Tunnel Questionnaire—symptom scale; BCTQ—FS, Boston Carpal Tunnel Questionnaire—functional scale. The green squares represent the differences between the means of each of the two groups compared, i.e., the mean differences. The size of the green square represents how much that individual study affects the overall outcome of the meta—analysis, i.e., the weight of the studies on the meta—analysis. The precision of the study depends on the 95% confidence interval for that mean difference, i.e., the length of the straight lines, the shorter the lines, the more precise the mean differences. The black trapezoid is the pooled mean difference of all the studies combined in consideration of the weight of each study, with its confidence interval extending from the left tip to the right tip.
Figure 4
Figure 4
Meta—analysis of UPIT with D5W vs. control injections. VAS, visual analogue scale; BCTQ—SS, Boston Carpal Tunnel Questionnaire—symptom scale; BCTQ—FS, Boston Carpal Tunnel Questionnaire—functional scale. The green squares represent the differences between the means of each of the two groups compared, i.e., the mean differences. The size of the green square represents how much that individual study affects the overall outcome of the meta—analysis, i.e., the weight of the studies on the meta—analysis. The precision of the study depends on the 95% confidence interval for that mean difference, i.e., the length of the straight lines, the shorter the lines, the more precise the mean differences. The black trapezoid is the pooled mean difference of all the studies combined in consideration of the weight of each study, with its confidence interval extending from the left tip to the right tip.
Figure 5
Figure 5
Meta—analysis of UPIT with higher volumes of D5W vs. lower volumes of D5W. VAS, visual analogue scale. The green squares represent the differences between the means of each of the two groups compared, i.e., the mean differences. The size of the green square represents how much that individual study affects the overall outcome of the meta—analysis, i.e., the weight of the studies on the meta—analysis. The precision of the study depends on the 95% confidence interval for that mean difference, i.e., the length of the straight lines, the shorter the lines, the more precise the mean differences. The black trapezoid is the pooled mean difference of all the studies combined in consideration of the weight of each study, with its confidence interval extending from the left tip to the right tip.
Figure 6
Figure 6
Meta—analysis of UPIT with PRP vs. control treatments. VAS, visual analogue scale; BCTQ—SS, Boston Carpal Tunnel Questionnaire—symptom scale; BCTQ—FS, Boston Carpal Tunnel Questionnaire—functional scale. The green squares represent the differences between the means of each of the two groups compared, i.e., the mean differences. The size of the green square represents how much that individual study affects the overall outcome of the meta—analysis, i.e., the weight of the studies on the meta—analysis. The precision of the study depends on the 95% confidence interval for that mean difference, i.e., the length of the straight lines, the shorter the lines, the more precise the mean differences. The black trapezoid is the pooled mean difference of all the studies combined in consideration of the weight of each study, with its confidence interval extending from the left tip to the right tip.
Figure 7
Figure 7
Meta—analysis of UPCTR vs. surgery. BCTQ—SS, The Boston Carpal Tunnel Questionnaire—symptom scale; BCTQ—FS, The Boston Carpal Tunnel Questionnaire—functional scale. The green squares represent the differences between the means of each of the two groups compared, i.e., the mean differences. The size of the green square represents how much that individual study affects the overall outcome of the meta—analysis, i.e., the weight of the studies on the meta—analysis. The precision of the study depends on the 95% confidence interval for that mean difference, i.e., the length of the straight lines, the shorter the lines, the more precise the mean differences. The black trapezoid is the pooled mean difference of all the studies combined in consideration of the weight of each study, with its confidence interval extending from the left tip to the right tip.
Figure 1
Figure 1
PRISMA flow diagram showing the selection of studies.

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