Ultrasound guided hydrodissection versus open surgery in patients with severe carpel tunnel syndrome: a randomized controlled study

Abstract Background Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome. Surgical release of severe CTS is the standard care management option. Ultrasound (US) guided hydrodissection is a recent minimally invasive procedure creating a perineural fluid plane and mechanically releasing perineural adhesions. Results 27 patients with severe CTS were recruited and divided into 2 groups: US guided HD included 12 patients and surgically managed CTS group included 15 patients. Demographic data, Visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), Phalen test, electrophysiological tests, US median nerve cross sectional area (CSA) for both groups were recorded and evaluated before the study and 3 months after the inventions. Comparison between the two groups regarding age, gender, type of work, affected side and dominant hand revealed statistically insignificant differences. BCTQ and VAS scale had improved in both groups after both interventions, comparing both groups revealed statistically insignificant differences. Electrophysiologic studies revealed no significant differences before interventions ( P > 0.05), while showed significant difference in favor of surgical group for distal motor latency (DML) after interventions ( P < 0.05). The Phalen test also improved in both groups after interventions, and this improvement was of statistical significance in favor of the surgical group. Lastly, US median nerve CSA showed improvements in both groups after the interventions without statistically significant difference. Conclusions US-guided hydrodissection of the median nerve for patients with severe forms of CTS is a safe, effective alternative to surgery especially for patients who are unfit for or refusing surgery.