Plastic and Reconstructive Surgery, Global Open (Mar 2024)

Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique

  • Kyle R. Eberlin, MD,
  • Benjamin P. Amis, MD,
  • Thomas P. Berkbigler, MD,
  • Christopher J. Dy, MD, MPH,
  • Mark D. Fischer, MD,
  • James L. Gluck, MD,
  • F. Thomas D. Kaplan, MD,
  • Thomas J. McDonald, MD,
  • Larry E. Miller, PhD, PStat,
  • Alexander Palmer, DO,
  • Paul E. Perry, MD,
  • Marc E. Walker, MD, MBA,
  • James F. Watt, DO

DOI
https://doi.org/10.1097/GOX.0000000000005665
Journal volume & issue
Vol. 12, no. 3
p. e5665

Abstract

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Background:. Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques. Methods:. In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0–10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year. Results:. Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (−1.8 versus -1.8; P = 0.96), BCTQ-FSS (−1.0 versus −1.0; P = 0.75), numeric pain scale (−3.9 versus −3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group. Conclusions:. CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.