Carpal Tunnel Release Using Ultrasound Guidance: Two-Year Outcomes of a Randomized Controlled Trial Within the Military- Journal of Hand Surgery Global Online
M smith, x yuan, j banks deal jr, g nanos III, s tintle, n hager, d reece, m miller
Purpose: The primary objective was to compare the short-term (1-month) and long-term (2-year) outcomes of carpal tunnel release (CTR) using ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) within the United States military population.
Methods: This single-site, prospective, randomized controlled trial enrolled military beneficiaries with carpal tunnel syndrome (CTS). Participants were randomized to receive either CTR-US in the clinic procedure room setting or mOCTR. Demographics and patient-reported outcome measures (PROs) were collected at baseline and follow-up PROs out to 2-years postprocedure. The primary outcome was the Quick Disabilities of the Arm, Shoulder, and Hand at 1 month. Additional outcomes included the Numeric Pain Rating Scale, Boston Carpal Tunnel Questionnaire – Symptom Severity Scale, Modified 2-item CTS Palmar Pain Scale, and adverse events (2-year window). Complete-case, intention-to-treat, generalized additive models (α = 0.05) were used to compare PROs between groups.
Results: Forty-one participants (58.5% women, 49.5 ± 14.4 years, 41.5% active duty) were randomized and treated (21 CTR-US, 20 mOCTR) with 100% follow-up at 2 years. Both groups demonstrated improved Quick Disabilities of the Arm, Shoulder, and Hand (CTR-US: −8.2 ± 17.1; mOCTR: −8.4 ± 13.6), Boston Carpal Tunnel Questionnaire – Symptom Severity Scale (CTR-US: −0.9 ± 0.8; mOCTR: −1.2 ± 0.7), and Numeric Pain Rating Scale (CTR-US: −1.1 ± 2.7; mOCTR: −1.1 ± 2.1) scores at 1 month with sustained clinically meaningful improvement out to 2 years. The CTR-US group reported less incisional pain and functionally limiting incisional pain during the first 4 and 3 weeks, respectively. One infection was reported in the CTR-US group.
Conclusions: Both groups had clinically meaningful improvements out to 2 years with respect to pain and CTS symptom reduction, as well as improvement in function. Compared to mOCTR, the CTR-US group reported less incisional pain and functionally limiting incisional pain in the early postprocedural period.
Marin S. Smith, Xiaoning Yuan, J. Banks Deal, George P. Nanos, Scott M. Tintle, Nelson A. Hager, David E. Reece, Matthew E. Miller, Carpal Tunnel Release Using Ultrasound Guidance: Two-Year Outcomes of a Randomized Controlled Trial Within the Military, Journal of Hand Surgery Global Online, Volume 8, Issue 5, 2026, 101078, ISSN 2589-5141; doi.org/10.1016/j.jhsg.2026.101078.