Comparison of ultrasound-guided needle-knife release of the transverse carpal ligament with glucocorticoid injection in the treatment of carpal tunnel syndrome: a randomized trial

Background: Ultrasound-guided needle-knife release of the transverse carpal ligament (TCL) has the potential to treat mild-to-moderate carpal tunnel syndrome (CTS). This study aimed to compare the clinical efficacy and safety of ultrasound-guided needle-knife release of the TCL with those of glucocorticoid injection therapy.

Methods: A total of 27 patients with mild or moderate CTS, involving 32 carpal tunnels, were enrolled between September 2025 and January 2026. They were randomly assigned to either the ultrasound-guided needle-knife therapy group (Group T, 17 carpal tunnels) or the ultrasound-guided glucocorticoid injection group (Group C, 15 carpal tunnels). Functional scores, Numerical Rating Scale (NRS) numbness and pain scores, Boston carpal tunnel questionnaire (BCTQ) scale scores, and 36-Item Short Form Health Survey (SF-36) scale scores were recorded and compared between groups at baseline, 1 month, and 3 months post-treatment. Clinical efficacy rates were assessed using the Kelly criteria.

Results: Compared with baseline, at 1 and 3 months post-treatment, Group T showed a significant improvement in carpal tunnel function scores (P=0.011, P<0.001); a significant reduction in NRS pain scores (P=0.006, P<0.001); the NRS numbness score decreased significantly (P<0.001), with better results observed at 3 months post-treatment compared to 1 month post-treatment (P=0.014); and the Symptom Severity Scale (SSS) score of BCTQ scale decreased significantly (P=0.0179, P<0.001); the physical functioning (PF), bodily pain (BP), role physical (RP), general health (GH), role emotional (RE), and social functioning (SF) scores of SF-36 scale all increased significantly (P<0.05). Compared with baseline, in Group T, the Functional Status Scale (FSS) score of the BCTQ scale decreased significantly by 3 months after treatment (P=0.028), and the vitality (VT) and mental health (MH) scores of the SF-36 scale both increased significantly (P<0.05). Group C showed improvement in the aforementioned scores at both 1 and 3 months post-treatment compared to baseline, but the magnitude was smaller than that of Group T and did not differ significantly from baseline (P>0.05). Furthermore, the efficacy at 3 months post-treatment in the corticosteroid injection group was almost indistinguishable from that at 1 month, indicating poorer long-term efficacy. According to the Kelly criteria, the overall response rate was higher in Group T than in Group C. There were significant differences between Group T and Group C in terms of carpal tunnel function, Visual Analog Scale (VAS), NRS, BCTQ, and SF-36 scores (P<0.05).

Conclusions: Ultrasound-guided needle-knife release of the TCL demonstrated superior efficacy compared to glucocorticoid injection.