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

• Published in: Plastic and reconstructive surgery. Global open Vol. 12; no. 3; p. e5665
• Main Authors: Eberlin, Kyle R, Amis, Benjamin P, Berkbigler, Thomas P, Dy, Christopher J, Fischer, Mark D, Gluck, James L, Kaplan, F Thomas D, McDonald, Thomas J, Miller, Larry E, Palmer, Alexander, Perry, Paul E, Walker, Marc E, Watt, James F
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01.03.2024; Wolters Kluwer
• Subjects: Original; Peripheral Nerve
• ISSN: 2169-7574; 2169-7574
• DOI: 10.1097/GOX.0000000000005665

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. 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. 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; = 0.96), BCTQ-FSS (-1.0 versus -1.0; = 0.75), numeric pain scale (-3.9 versus -3.8; = 0.74), and EQ-5D-5L (0.13 versus 0.12; = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; = 0.005). Complications occurred in 2.1% versus 3.6% of patients ( = 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. 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.