Ultrasound-Guided Percutaneous Needle Electrolysis Versus Surgery for Carpal Tunnel Syndrome: A Randomized Clinical Trial

<b>Background/Objectives</b>: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. The aim of this study was to analyze the safety and effectiveness of ultrasound-guided percutaneous needle electrolysis (PNE) and open carpal tunnel release (OCTR) in patients with moderate-to-severe CTS. <b>Methods</b>: A total of 185 patients with idiopathic CTS were assigned to either the electrolysis group (75 patients) or the surgery group (73 patients); 112 patients completed the final follow-up assessment 12 months after randomization. The surgical procedure consisted of OCTR. The electrolysis group received four sessions of US-guided PNE applied every seven days. Main outcomes were nights waking up due, pain, paresthesia, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS), Functional Status Scale (BCTQ FSS) and adverse events. These variables were evaluated in the short (6 weeks), medium (3 months), and long term (6 and 12 months). <b>Results</b>: In the short term (6 weeks), both interventions did not show significant differences in the severity of symptoms; however, the electrolysis group had less adverse events than the surgery group (2 vs. 100). In the medium (3 months) and long term (6 and 12 months), surgery was slightly more effective regarding nocturnal awakenings, paresthesia and BCTQ-SSS (<i>p</i> < 0.002). <b>Conclusions</b>: US-guided PNE may be a safe and effective technique for patients with moderate-to-severe CTS with a sustained long-term pattern of improvement. Although both treatments were effective, OCTR showed superior long-term symptom reduction. Therefore, PNE may serve as a first-line or bridging treatment in selected clinical scenarios.