Ultrasound-guided carpal tunnel release outside the operating theatre. Patient satisfaction, hand function, and symptomatology. A systematic review. 

Ultrasound-guided carpal tunnel release outside the operating theatre. Patient satisfaction, hand function, and symptomatology. A systematic review. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Ultrasound-guided carpal tunnel release outside the operating theatre. Patient satisfaction, hand function, and symptomatology. A systematic review. Oana Diana Damian, Claire Simpson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8968369/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Carpal tunnel syndrome (CTS) is a prevalent neuropathy that affects individuals' quality of life and causes significant socioeconomic costs. Traditional treatments include surgical decompression, but a novel minimally invasive technique, ultrasound-guided carpal tunnel release (USG-CTR), offers similar outcomes with potentially lower costs and greater convenience. This systematic review evaluates the effectiveness of USG-CTR conducted in procedures (PR) and interventional radiology rooms (IR) compared with operating rooms (OR) in terms of patient satisfaction, hand function, and symptomatology. Methods A detailed search was conducted using the EMBASE, MEDLINE, CENTRAL, and Scopus databases up to May 2024. The inclusion criteria were studies assessing USG-CTR outcomes in different settings using standardized measures such as the Boston Carpal Tunnel Questionnaire (BCTQ) and the visual analog scale. Improvements were expressed as mean changes in the BCTQ functional and symptom severity scores. Bias assessment was performed using the Joanna Briggs Institute critical appraisal checklists. Results From the 296 screened studies, 9 met the inclusion criteria: 1 RCT, 1 retrospective cohort study, and 7 case series. High levels of patient satisfaction were reported across the PR and IR settings, with significant improvements in BCTQ functional status scale and symptom severity scale scores. No substantial differences were observed between the PR, IR, and OR settings in terms of symptom relief and functional outcomes. Conclusion Current evidence suggests that the USG-CTR in PR and IR settings is as effective as it is in OR settings, offering high patient satisfaction and improved hand function and symptomatology. These findings support the adoption of the USG-CTR in nontraditional settings to potentially reduce costs and increase accessibility. Future research should standardize outcome measures and explore long-term effects across various settings. carpal tunnel syndrome ultrasound-guided release ambulatory surgery patient satisfaction functional outcome BCTQ Figures Figure 1 Figure 2 Figure 3 1. Background Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the carpal tunnel level. It is diagnosed mainly through medical history and clinical examination. Neurophysiological testing confirms the diagnosis and grades the severity of the neuropathy. CTS commonly occurs between 30 and 60 years of age, with a reported incidence of 6% in the general population [ 1 ], and it is up to 3 times more common in females [ 2 , 3 ]. The impact of this pathology is seen at both the socioeconomic and individual levels, affecting the patient's quality of life. CTS symptomatology can affect one's ability to perform daily activities, resulting in medical leave, sleep disturbances, and psychological stress [ 4 ]. The economic impact of the pathology is based on the health care cost incurred and the patient's cumulative loss of income. According to a study conducted in the USA, patients with CTS experience a loss in income of $ 45,000– $ 89,000 over 6 years [ 5 ]. For patients with mild symptoms, management with medications and splints may be an option. Surgical decompression of the median nerve by division of the transverse carpal ligament (TCL) is reserved for patients with severe symptoms, including sensory or motor impairment, and those with refractory symptoms of more than six months. Both open and endoscopic techniques can achieve surgical decompression of the carpal tunnel [ 1 , 2 , 6 ]. However, a new carpal tunnel release (CTR) technique has recently emerged. Ultrasound-CTR (USG-CTR) has gained popularity and interest in the literature [ 7 – 10 ]. This innovative procedure, which can be carried out without an incision using an abrasive thread, a needle, a hook blade, or a specialized device such as UltraGuideCTR™ (Sonex Heath, Inc., Eagan, MN, USA), offers a promising future for CTS treatment. The procedure can be performed under local or general anesthesia in an ambulatory or operating room setting. Additionally, to the best of our knowledge, the literature shows comparable safety and effectiveness between open and ultrasound-guided techniques [ 7 – 12 ]. Considering the impact of carpal tunnel syndrome (CTS) on affected individuals, the growing clinical interest in USG-CTR as a treatment option, and the increasing tendency to perform carpal tunnel release in outpatient settings [ 7 – 13 ], we conducted a search on the PROSPERO platform to find ongoing systematic reviews that assess patient satisfaction, symptomatology, and hand function following USG-CTR in both operating room (OR) and procedure room (PR) settings. However, no results were found, signaling a gap in the literature. Performing this intervention outside the operating theatre could lower hospitalization costs and open more hours for the operating theatre. Conversely, unclear barriers might hinder clinicians from making the PR setting a standard-setting option for the USG-CTR [ 12 ]. As such, this systematic review of the USG-CTR may offer preliminary evidence supporting USG-CTR office-based treatment as an effective option. 1.1. Study aim and hypothesis This study aims to investigate the literature on the USG-CTR to determine to what extent it may be an effective option for procedure room treatment in terms of global patient satisfaction, hand function, and symptomatology. We hypothesized that USG-CTR conducted in procedure rooms would yield the same or higher patient satisfaction and the same improvement in hand symptomatology and function as those conducted in an operating room. 2. Methodology [14] This systematic review is based on the PICO framework [ 15 ] to meticulously structure the methodology for evaluating the effectiveness of the USG-CTR as a therapeutic intervention for CTS. Table 1 presents the detailed PICO framework employed in our study, delineating the patient population, intervention, comparison, and outcomes, with the addition of the study design. This structured approach facilitates a comprehensive and systematic assessment of the effectiveness of the USG-CTR in treating CTS, ensuring a rigorous analysis of the relevant literature. Table 1 PICO Framework Element Description Patients Patients who underwent carpal tunnel release Intervention Ultrasound-guided carpal tunnel release in procedure room setting Comparator Ultrasound-guided carpal tunnel release in operating room setting Outcomes Patient satisfaction and hand function and symptomatology scores Studies Systematic reviews, RCTs, cohort studies, pro/retrospective studies Additionally, in our study, we used a PRISMA flow diagram (Fig. 1), to show how the studies were selected. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram is a tool that helps visualize each step of the review process. It outlines how many records were identified, screened, included, and excluded, along with the reasons for exclusions [ 16 ].This systematic review was reported in accordance with the PRISMA 2020 statement (completed PRISMA 2020 checklist provided in Additional file 1). 2.1. Databases and search strategy Four databases—Ovid EMBASE, Ovid MEDLINE, CENTRAL, and Scopus—were searched to identify relevant literature from their inception to May 6th, 2024. The search strategy included the terms “carpal tunnel release” OR “carpal tunnel decompression” AND “guided” AND “ultrasound” OR “echography” OR “sonography”. A single reviewer performed the literature search without imposing any restrictions. A manual search of the articles' references for additional relevant studies was not conducted. 2.2. Study inclusion and exclusion criteria The inclusion criteria were as follows: 1) English-language systematic reviews of randomized controlled trials (RCTs), pragmatic cohort studies, retrospective and prospective studies, cohort studies, and case series studies in humans that assess the outcomes of USG-CTR for CTS; 2) studies that precisely specify the setting where the USG-CTR intervention took place: operating room (OR), procedure room (PR), or interventional radiology room (IR); 3) studies that measured the outcomes of interest using standardized questionnaires, namely, the visual analog scale (VAS) (self-reported, interviewer-administered by telephone or email/web-based), for assessing patient satisfaction and the Boston Carpal Tunnel Questionnaire (BCTQ) for assessing hand function and symptomatology [ 17 ]. The exclusion criteria were as follows: 1) cadaveric studies, ongoing studies, preliminary results studies, and studies for which full-text retrieval was impossible; 2) studies with mixed specified intervention settings that did not present the outcome for the operating and procedure room interventions separately. Two independent reviewers screened the title and abstract and performed the full-text review using the web-based collaboration software platform Covidence [ 18 ]. The third reviewer, the supervisor of the systematic review, acted as a mediator and final decision-maker in resolving the conflicts at the abstract review level. 2.3. Data extraction Data extraction was performed by the first author using Covidence. Several aspects were considered before beginning the process: First, the classification of IR facilities consists of 3 classes. Class 1 does not require the same environmental control as PRs and is used as an examination/procedure room. Class 2 does not require the same environmental control as ORs and is used for minimally invasive procedures. Class 3 has the same status as an OR [ 19 ]. Therefore, IRs fall between ORs and PRs in terms of invasiveness and risk assessment, depending on their classification. Additionally, a PR requires a different level of environmental control compared with a Class 2 IR [ 19 ]. In this review, in cases where the status of the IR is not specified, we coded it as an OR setting. Another essential aspect considered during the data extraction was to focus on both components of BCTQ, namely, the functional status score (FSS) and symptom severity score (SSS), rather than on the overall BCTQ score. This decision was based on recent research indicating that the overall score of the BCTQ is not psychometrically valid and that the questionnaire's subscales should be used for interpreting data [ 20 , 21 ]. In the end, the collected data included study identification details, start and end dates of the study, type of study, inclusion and exclusion criteria, hand and participant sample size, number and reason for withdrawals, intervention setting, patient satisfaction based on VAS or other standardized questionnaires, and hand symptomatology and function based on the BCTQ-SSS and BCTQ-FSS scores measured preoperatively and at 3 months, 6 months, and 1 year of follow-up. Hand side and hand dominance were not considered. 2.4. Bias assessment In this review, the Joanna Biggs Institute (JBI) Critical Appraisal Checklist (CAC) was used to evaluate the risk of bias. Given the limited research experience of the authors, this checklist was chosen because it provides detailed guidance for each question assessing various domains of different types of studies [ 22 – 24 ]. In addition, according to the official JBI site, peer reviews have extensively validated the checklist [ 25 ]. The authors assessed the risk of bias for the included studies using the JBI CAC for case series [ 24 ], cohort studies [ 23 ], and RCTs [ 22 ]. To deem the overall risk of bias low, 7 of the 10 domains on the JBI-CAC for Case Series, 8 of the 11 domains on the JBI-CAC for cohort studies, and 10 of the 13 domains on the JBI-CAC for RCTs had to be appraised as “YES.” 2.5. Software tools and study analysis In this research, three software tools were used to facilitate data analysis and visualization. Microsoft Excel, which is part of the Microsoft 365 suite [ 26 ], was used for data organization and advanced analysis, while OpenAI ChatGPT [ 27 ] was employed for computing descriptive statistics and for generating tables and graphs to support interpretation and analysis. Furthermore, Covidence [ 18 ], a web-based collaboration software platform that streamlines the production of systematic and other literature reviews, was used. This tool was instrumental in generating a PRISMA flow diagram. Covidence [ 18 ] was also used to calculate Cohen's kappa coefficient [ 28 ], which assesses the level of agreement between reviewers and measures the reliability level of the review process. Finally, the descriptive analysis of the case series was conducted separately from the descriptive analysis of the RCT and cohort studies. This approach allowed us to scrutinize the case series independently, ensuring a comprehensive understanding of its characteristics and implications. Effect measures used were mean difference (change from baseline) for BCTQ-FSS and BCTQ-SSS. No sensitivity analyses were conducted due to the limited number of included studies and the high heterogeneity of the extracted data. No formal assessment of reporting bias (e.g., funnel plot or small-study effects analysis) was performed due to the small number of included studies. No formal certainty of evidence assessment (e.g., GRADE approach) was conducted. 3. Results 3.1. Study type and selection From the initial screening, 296 studies were imported into Covidence. We identified 4 duplicates manually and 154 duplicates using Covidence and marked 53 studies as ineligible with automation tools. Eighty-five studies were identified as potentially relevant for our study, of which 9 were ultimately included. The included studies comprised 1 RCT [ 7 ], 1 retrospective uncontrolled cohort study [ 29 ], 4 prospective case series [ 12 , 30 – 32 ], 2 retrospective case series [ 33 , 34 ] and 1 retrospective case series review of prospectively collected data [ 35 ]. Figure 1 provides a step-by-step breakdown of the review process. 3.2. Bias analysis Table 2 shows the critical appraisal of the 7-case series [ 12 , 30 – 35 ] included in the study. On the basis of the JBI CAC for case series [ 24 ], 3 of the 7 case series studies had a low risk of bias, while the remaining studies had a high risk of bias. RCTs [ 7 ] were found to have a high risk of bias, with 8 out of 13 domains assessed as “YES.” The included retrospective uncontrolled cohort study [ 29 ] was found to have a low risk of bias, with 9 out of 11 domains assessed as “YES.” Table 2 Critical Appraisal of the 7-Case Series Included in the Systematic Review Author Chappell et al. 2020 [ 35 ] Petrover et al. 2017 [ 32 ] Guo et al. 2017 [ 30 ] Kamel et al. 2021 [ 34 ] Chern et al. 2015 [ 31 ] Mende et al. 2023 [ 33 ] Bergum et al. 2022 [ 12 ] Complete Inclusion 1 1 0 1 1 U 1 Condition Measure U 0 0 0 1 1 1 Consecutive Inclusion 1 1 0 1 1 U 1 Inclusion Criteria 1 1 1 1 1 1 1 Methods Used for Condition Identification U 0 1 0 1 1 1 Outcome or Follow-up 1 1 1 1 0 1 1 Participants' Clinical Information 0 0 1 U U U 1 Participants' Demographics 1 0 1 1 1 1 1 Site/Clinic(s) Demographics 0 0 0 0 0 1 1 Statistical Analysis 1 1 0 1 U 1 1 Total 6 5 5 6 6 7 10 % Risk of Bias 40 50 50 40 30 30 0 Note: The table shows the critical appraisal of the 7-case series included in the study on the basis of the JBI CAC for case series [ 24 ]. In this table, "1" indicates "Yes", "0" indicates "No", and "U" indicates "Unclear". 3.3. Study characteristics and design Different approaches for measuring the outcomes of interest have been identified in the selected literature. Specifically, the RCT [ 7 ] included in the review investigated the clinical effectiveness of minimally invasive USG-CTR vs. open release for treating CTS. However, the FSS and SSS scores differed only between the USG-CTR and open carpal tunnel release surgery; consequently, comparisons with other studies were impossible. A cohort study [ 29 ] aimed to investigate the long-term outcomes and clinical effectiveness of USG-CTR by thread dissection in severe CTS. This study compared the severity of 2 groups of CTS, which were graded using Bland's classification [ 36 ]. Neither the RCT nor the cohort study included patient satisfaction as an outcome of interest. In 7 case series [ 12 , 30 – 35 ], the feasibility, safety, and short-term or long-term clinical outcomes of existing, new, or modified USG-CTR techniques were presented. Two studies were performed in an interventional radiology room (IR) [ 32 , 34 ], 4 in a procedure room (PR) [ 12 , 30 , 33 , 35 ] and 1 in an operating room (OR) [ 31 ]. Only two studies, those by Mende et al. [ 33 ] and Kamel et al. [ 34 ], included patient satisfaction outcomes. Mende et al. [ 33 ] used a visual analog scale (VAS) ranging from 0 to 10 to assess patient satisfaction. However, the data presented were unclear and incomplete—no baseline scores for patient satisfaction were reported. Kamel et al. [ 34 ] employed a 5-point global satisfaction metric to score patient experiences. The scale ranged from 1 = very dissatisfied to 5 = very satisfied. Their findings revealed that 83% (38 out of 46) of the patients expressed satisfaction or extreme satisfaction with the procedure at the 2-week follow-up. This satisfaction rate increased to 93% (37 out of 40) during long-term follow-up. Furthermore, the authors reported a statistically significant moderate inverse correlation between patient satisfaction and the BCTSQ score at the long-term follow-up [ 34 ]. However, it is unclear whether the long-term follow-up was the same as the maximum 1-year follow-up reported for the BCTQ. All the case series studies except those by Mende et al. [ 33 ] provided clear data for the BCTQ FSS and SSS outcomes. One study [ 34 ] provided incomplete descriptive statistics, with the standard deviation (SD) for the FSS and SSS scores missing. Chappell et al. [ 35 ] reported the outcome of interest 6–10 weeks after surgery, which is less than 3 months, making it unsuitable for our analysis. Five studies [ 12 , 30 – 32 , 34 ] reported different follow-up periods. Only Chern et al. [ 31 ] and Guo et al. [ 30 ] reported follow-up outcomes at 6 months and 1 year. Petrover et al. [ 32 ] provided data at 6 months; Bergum et al. [ 12 ] and Kamel et al. [ 34 ] provided data at 1 year. All five studies conducted statistical analyses on hand sample sizes. 3.4 Results analysis The minimal detectable changes (MDC) at a 95% confidence interval considered in this review were .85 for SSS and .94 for FSS, in accordance with recent reports in the literature [ 20 , 21 ]. Furthermore, a minimal clinically important difference (MCID) of 1.05 for the SSS and 1.13 for the FSS was calculated from the reported baseline score [ 21 ]. Additionally, factors such as sample size (Table 3 ), SD (Table 4 ), risk of bias (Table 2 ), USG-CTR technique, mean age, sex distribution (Table 5 ) and severity grading of the CTS from each study were not considered because of the high heterogeneity of the data extracted. Table 3 Hand Sample Size for BCTQ-FSS and BCTQ-SSS Over Time Author BCTQ-FSS BCTQ-SSS Baseline 6 Months 1 Year Baseline 6 Months 1 Year Bergum et al., 2020 [ 12 ] 123 123 123 123 Chern et al., 2015 [ 31 ] 91 91 91 91 91 91 Guo et al., 2017 [ 30 ] 159 96 41 159 96 41 Kamel et al., 2021 [ 34 ] 61 61 61 61 Petrover et al., 2017 [ 32 ] 129 123 129 123 Note: BCTQ-FSS = Boston Carpal Tunnel Questionnaire Functional Status Scale; BCTQ-SSS = Boston Carpal Tunnel Questionnaire Symptom Severity Scale. Table 4 Standard Deviation of BCTQ-FSS and BCTQ-SSS Scores Author BCTQ-FSS BCTQ-SSS Baseline 6 Months 1 Year Baseline 6 Months 1 Year Bergum et al., 2022 [ 12 ] .07 .05 .07 .05 Chern et al., 2015 [ 31 ] .95 .16 .16 .98 .29 .16 Guo et al., 2017 [ 30 ] .89 .66 .25 .71 .51 .30 Kamel et al., 2021 [ 34 ] n/a n/a n/a n/a Petrover et al., 2017 [ 32 ] 1.1 .50 .70 .30 Note: BCTQ-FSS = Boston Carpal Tunnel Questionnaire - Functional Status Scale; BCTQ-SSS = Boston Carpal Tunnel Questionnaire - Symptom Severity Scale. ‘n/a ‘data not available. Table 5 Summary of Equipment, Mean Age, and Sex Distribution Author Equipment Mean Age Males (%) Females (%) Bergum et al., 2022 [ 12 ] Device* 66.0 43.0 57.0 Chern et al., 2015 [ 31 ] Hook knife 50.6 22.5 77.5 Guo et al., 2017 [ 30 ] Thread 54.8 33.62 66.37 Kamel et al., 2021 [ 34 ] Device 60.7 46.0 54.0 Petrover et al., 2017 [ 32 ] Hook knife 61.5 30.2 69.8 Note: Equipment refers to the instrument used in the technique to dissect the TCL. *Device: SX-One MicroKnife, Sonex Health Inc., Eagan, MN, USA. 3.4.1. Case series analysis As previously mentioned, 7 case series [ 12 , 30 – 35 ] were considered in this review, of which only 5 [ 12 , 30 – 32 , 34 ] were incorporated into the analysis. The exclusion of 2 studies was necessary for specific reasons. The study conducted by Chappell et al. [ 35 ] was not included because it reported the outcome of interest at follow-ups of less than 3 months; therefore, it did not meet the criteria for this analysis. In addition, the study conducted by Mende et al. [ 33 ] was excluded because of the provision of unclear and incomplete data, which would otherwise compromise the integrity of this analysis. When the 5 included studies were analyzed, the hand samples reported by Chern et al. for the BCTQ-FSS and BCTQ-SSS outcomes were inconsistent and unclear [ 31 ]. The authors reported 91 hands postintervention and the loss of 3 hands at follow-up, resulting in 88 hands. However, the authors did not specify how they handled missing data during post hoc tests. A similar situation was encountered by Guo et al., who reported the most significant loss of hands at follow-up, from 159 hands at baseline to 41 hands at 1 year [ 30 ]. A comparative analysis of the means for BCTQ FSS and SSS outcomes, measured at baseline, 6 months, and 1 year, was conducted across the case series studies in diverse settings (IR, OR, and PR). The IR setting included the studies by Petrover et al. [ 32 ] and Kamel et al. [ 34 ], the OR setting included the study by Chern et al. [ 31 ], and the PR setting included the studies by Bergum et al. [ 12 ] and Guo et al. [ 30 ]. This comparison is visually represented in Tables 6 and 7 and Fig. 2. Table 6 Comparative Analysis of the Case Studies BCTQ FSS and SSS Study Setting Outcome Baseline 6 Months 1 Year Bergum et al., 2022 [ 12 ] PR BCTQ-FSS 2.65 - 1.41 BCTQ-SSS 3.14 - 1.41 Chern et al., 2015 [ 31 ] OR BCTQ-FSS 2.67 1.3 1.07 BCTQ-SSS 2.75 1.25 1.07 Guo et al., 2017 [ 30 ] PR BCTQ-FSS 2.56 1.2 1.11 BCTQ-SSS 3.19 1.19 - Kamel et al., 2021 [ 34 ] IR BCTQ-FSS 2.5 - 1.1 BCTQ-SSS 3.2 - 1.2 Petrover et al., 2017 [ 32 ] IR BCTQ-FSS 2.6 1.3 - BCTQ-SSS 3.3 1.3 - Note: IR = Interventional Radiology Room, OR = Operating Room, PR = Procedure Room; BCTQ-FSS = Boston Carpal Tunnel Questionnaire Functional Status Scale, BCTQ-SSS = Boston Carpal Tunnel Questionnaire Symptom Severity Scale; Baseline, 6 months, 1 year: Measurement time points for the outcomes. Table 7 Mean Averages for IR and PR Setting Outcome Baseline 6 Months 1 Year IR BCTQ-FSS 2.55 1.3 1.1 BCTQ-SSS 3.25 1.3 1.2 PR BCTQ-FSS 2.6 1.2 1.26 BCTQ-SSS 3.16 1.19 1.27 Note: IR = Interventional Radiology Room; PR = Procedure Room; BCTQ-FSS = Boston Carpal Tunnel Questionnaire Functional Status Scale; BCTQ-SSS = Boston Carpal Tunnel Questionnaire Symptom Severity Scale; Baseline, 6 months; 1 year: Measurement time points for the outcomes. Figure 2. Mean Average BCTQ-FSS and BCTQ-SSS Scores Across Different Settings Over Time. Note FSS (Boston Carpal Tunnel Questionnaire-Functional Status Scale) and SSS (Boston Carpal Tunnel Questionnaire-Symptom Severity Scale) scores were measured for operating (OR), procedure (PR), and interventional radiology rooms (IR). Data sourced from studies conducted by Bergum et al. [ 12 ], Chern et al. [ 31 ], Guo et al. [ 30 ], Kamel et al. [ 34 ], and Petrover et al. [ 32 ]. At baseline, the FSS and SSS scores varied from 2.5 to 2.7 points and 2.7 to 3.3 points, respectively. The baseline reported score for the patients treated in the OR setting was 2.67 points for the FSS and 2.75 points for the SSS. The baseline scores for the FSS and SSS among OR, IR, and PR patients were not significantly different. Furthermore, when the mean MA at baseline was computed for settings with a minimum of two studies, the IR setting patients exhibited an MA of 2.55 points for the FSS and 3.25 points for the SSS. Similarly, the PR setting demonstrated a mean average of 2.60 points for FSS and 3.12 points for SSS. These findings provided a comprehensive understanding of the BCTQ FSS and SSS baseline scores across different clinical settings, which we compare below. The IR and PR patients experienced the greatest significant changes in the SSS score at 6 months and 1 year. IR patients experienced a 2-point change at 6 months [ 32 ] and a 2-point change at 1 year [ 34 ], whereas PR patients experienced a mean change of 1.84 points at 1 year. In the OR study, the patient SSS changed by 1.5 points at 6 months and 1.68 points at 1 year, and in the FSS, it changed by 1.37 points at 6 months and 1.6 points at 1 year. When the FSS scores at the 1-year follow-up were compared, no distinct patterns emerged. Specifically, the study by Chern et al. [ 31 ], conducted in an OR setting, was compared with the PR setting studies by Guo et al. [ 30 ] and Bergum et al. [ 12 ]. Moreover, the studies were compared with the IR setting study by Kamel et al. [ 34 ]. According to Chern et al. [ 31 ], OR patients had the highest MCID (1.6 points). Conversely, among the four studies, Bergum et al. [ 12 ] reported the lowest MCID, specifically 1.25 points. Overall, this simple comparative analysis revealed that the improvements in FSS scores for the interventions conducted in the OR setting were similar to those from the IR and PR settings, with no notable differences detected. Similarly, the improvements in SSS scores for the interventions conducted in the PR and IR settings were comparable to those from the OR setting. Conversely, the IR and OR settings exhibited significantly greater variability compared with the PR setting after calculating a weighted average of the SD for BCTQ FSS and SSS. Specifically, the IR setting had a noticeably higher weighted average SD than did both the OR and PR settings. Notably, the OR setting included only one study, as Kamel et al. [ 34 ] did not provide SD values, which led to the exclusion of their study from the analysis. Consequently, considering the limited data for the OR and IR setting, these findings should be interpreted with caution. A visual representation of the differences between the selected settings is shown in Fig. 3 . All 5 case series studies demonstrated that the MDC and the MCID for the FSS and the SSS were consistently maintained above our set thresholds. Specifically, the MDC thresholds were .94 for FSS and .85 for SSS, whereas the MCID thresholds were 1.13 for FSS and 1.05 for SSS. These values were maintained at both the 6-month and 1-year follow-up points. 3.4.2 RCT and cohort study analysis The RCT [ 7 ] data of interest, although reported as FSS and SSS, highlighted the significant differences between USG-CTR and open carpal tunnel release surgery without providing patients' FSS and SSS outcomes for each procedure. This lack of disaggregated data rendered the RCT unsuitable for inclusion in our analysis. Kim et al.'s retrospective cohort study aimed to investigate the long-term outcomes (over 2 years) of USG-CTR by the thread technique while concurrently assessing its clinical effectiveness in patients with severe CTS [ 29 ]. The USG-CTR was conducted in a PR setting, with patients demonstrating MCIDs of 2.09, 2.16, and 2.18 points at the 6-month, 1-year, and 2-year follow-ups, respectively, from a baseline of 3.21 SSS. In terms of the FSS score, the MCID was 1.24, 1.34, and 1.38 points at the 6-month, 1-year, and 2-year follow-ups, respectively, from a baseline of 2.42 points. A separate analysis was conducted on a subset of 21 hands out of the total 82 included in the study. The subset analysis aimed to evaluate the clinical effectiveness of the procedure in patients diagnosed with grade 6 CTS compared with those with grade 1–5 CTS at the 6-month follow-up. CTS classification was based on neurophysiological results according to Bland’s grading system [ 36 ] and reported as follows: very mild (grade 1), mild (grade 2), moderate (grade 3), severe (grade 4), very severe (grade 5), and extremely severe (grade 6) [ 29 ]. Significant and more rapid improvements were observed in the FSS and SSS scores over 6 months for the CTS-grade 1–5 patients than for the CTS-grade 6 patients. However, owing to the small number of grade 6 CTS hands included in the study, these results should be interpreted with caution. Further validation through additional research is necessary. 4. Discussion The primary objective of this systematic review was to investigate the effectiveness of the USG-CTR as a procedure room treatment option. This review specifically compared patient satisfaction, hand function, and symptomatology between USG-CTR performed in procedure rooms and operating rooms. This review revealed high levels of patient satisfaction with the use of the USG-CTR in both the PR and IR settings. For instance, Kamel et al. [ 34 ] reported that 83% of patients were globally satisfied or extremely satisfied at 2 weeks, with this figure increasing to 93% at long-term follow-up. Mende et al. [ 33 ] reported similar findings regarding treatment satisfaction, although their data were incomplete. While these studies report favorable patient satisfaction outcomes, the inconsistency in measurement tools (e.g., visual analog scales and numerical rating scales) and incomplete data undermine the reliability of these findings. Significant improvements in BCTQ-FSS and BCTQ-SSS were observed across various studies, indicating effective symptom relief and functional enhancement. For instance, Guo et al. [ 30 ], who conducted their procedure in a PR setting, reported a decrease in BCTQ-FSS from 2.56 to 1.11 and in BCTQ-SSS from 3.19 to 1.19 at the 1-year follow-up, which is above the MDC and MCID thresholds and shows statistically significant improvements. Conversely, the IR and OR settings exhibited significantly greater variability than the PR setting did after a weighted average of the SD for BCTQ FSS and SSS was calculated. Specifically, the IR setting had a noticeably higher weighted average SD than did both the OR and PR settings. Notably, the OR setting included only one study, as Kamel et al. [ 34 ] did not provide SD values, which led to the exclusion of their study from the analysis. This exclusion affects the reliability of the comparison, as the variability assessment in the OR and IR settings is based on limited data. Therefore, these findings should be interpreted with caution. This positive trend was consistent across all five case series included in our comparative analysis, with the MDC and MCID remaining above the threshold at 6 months and 1 year. On the basis of the observed numbers, the improvements in FSS scores in the OR setting were similar to those in the IR and PR settings, showing no notable difference. Similarly, the improvements in SSS in the PR and IR settings were comparable to those in the OR setting, with no significant difference observed. It appears that the type of setting—whether OR, IR, or PR—does not make a noticeable difference in the observed improvements in FSS and SSS scores. Additionally, a cohort study by Kim et al. conducted in a PR setting demonstrated significant improvements in both the BCTQ-FSS and the BCTQ-SSS, regardless of CTS severity. However, the improvement rates varied across the severity groups over 6 months. Significant and more rapid improvements were observed in the FSS and SSS scores over 6 months for the CTS-grade 1–5 patients than for the CTS-grade 6 patients. Taken together, this finding empirically supports our hypothesis that USG-CTR conducted outside the operating theatre provides the same hand function and symptomatology outcomes as USG-CTR conducted in the OR. The evidence for improvements in hand function and symptomatology is moderately strong, as supported by the results of multiple case series and one cohort study that demonstrated significant postprocedure improvements. However, the reliance on case series, along with variability in follow-up durations and reporting methods, limits the generalizability of these findings. Nevertheless, the findings of this systematic review highlight the potential effectiveness of USG-CTR within the broader context of the literature, particularly concerning the procedures—IR, PR, and OR. While previous studies have focused predominantly on the clinical outcomes of USG-CTR, limited attention has been given to how the procedural setting affects patient satisfaction, hand function, and symptomatology. Studies by Kamel et al. [ 34 ] and Mende et al. [ 33 ] reported high levels of patient satisfaction with the USG-CTR in outpatient settings, which aligns with the general trend in the literature. For instance, a retrospective observational case series by Moscato et al. [ 37 ] examined patient satisfaction with a USG-CTR in office-based versus operating room (OR) settings and used a numerical analog scale from 0 (complete disappointment) to 10 (complete satisfaction) to collect patient-reported outcomes; the results revealed that satisfaction scores differed by only .50 points between the two settings, representing a statistically insignificant difference, with both studies demonstrating high levels of patient satisfaction. Despite the limitations of this study, it highlights the importance of patient-reported outcomes in different surgical settings and suggests a promising area for further research [ 37 ]. Other studies that did not focus on the intervention setting have also reported high levels of satisfaction and increased hand function and symptomatology after USG-CTR. Cano et al. reported a 91.2% satisfaction rate at 46 months in 162 hands treated with USG-CTR in both OR and outpatient settings, without distinguishing between the settings [ 38 ]. Similarly, Aguila et al. reported an 87.7% satisfaction rate and a mean procedure recommendation score of 8.9 out of 10 in 300 patients, further supporting the positive outcomes associated with the USG-CTR [ 39 ]. The effectiveness of USG-CTR in terms of patient satisfaction and BCTQ scores can be attributed to its minimally invasive nature, which reduces tissue damage and promotes faster healing [ 34 , 40 ]. Moreover, ultrasound guidance enhances surgical precision, potentially reducing the risk of injury to surrounding structures and leading to fewer postoperative complications [ 34 , 40 ]. Hall et al., in their retrospective chart review study, reported a complication rate of 2.3% in 128 patients who underwent ultrasound-guided carpal tunnel release (USG-CTR), with two reported infections and one hematoma [ 41 ]. Their results were similar to those from a systematic review by Benson et al. [ 42 ], which showed a total complication rate of .2% for endoscopic carpal tunnel release (CTR) and .5% for open CTR. Benson et al. reported complications, including neuropraxia, major nerve injury, digital nerve injury, tendon injury, and arterial arch injury, in 22,327 cases of endoscopic CTR and 5,669 cases of open CTR [ 41 , 42 ]. According to Apard and Candelier, their systematic review revealed no reports of iatrogenic arterial or nerve injuries or the occurrence of complex regional pain syndrome in the literature during UCTR procedures [ 43 ]. Overall, this set of evidence suggests similarly low complication risks postsurgery among open CTR, endoscopic CTR and USG-CTR. Moreover, regarding the rates of incomplete release of the TCL with USG-CTR, Lam et al. [ 44 ] reported in their systematic review two cases of persistent symptoms related to incomplete TCL dissection using the loop thread approach, as documented by Burnham et al. [ 45 ]. Additionally, Chern et al. reported one case of recurrent symptoms at the 2-year follow-up. During an ultrasound assessment, a hypertrophied TCL was identified, necessitating a second USG-CTR [ 31 ]. According to a systematic review and meta-analysis conducted by Vasiliadis et al., when comparing open CTR and endoscopic CTR, the risk of incomplete release of the TCL is greater with endoscopic CTR because of the limited visualization of the surgical field. This limitation increases the risk of incomplete release compared with open CTR, which is considered the gold standard because of its direct visualization and lower risk of incomplete release [ 46 ]. Ohuchi et al. proposed a new ultrasound-assisted endoscopic CTR technique to reduce the risk of incomplete carpal tunnel release and minimize the risk of damage to the superficial palmar arch [ 47 ]. Although few studies have been conducted on USG-CTR because of its status as a new technique, this proposed hybridization of endoscopic CTR highlights the enhanced surgical precision provided by ultrasound guidance, potentially resulting in lower risks of complications after surgery. Surgeons, in particular, might benefit from incorporating USG into CTS surgical treatment to avoid postoperative complications. With respect to shifting minimally invasive surgeries to office-based procedure rooms, this approach offers a promising solution to ease the burden on traditional ORs. It could minimize costs, making it more convenient for patients and health care providers alike. Optimizing resource use ensures broader access to medical services while maintaining high standards of patient safety and satisfaction [ 48 – 51 ]. Van Demark et al. explored the outcomes of hand surgeries performed on 111 patients over 18 months using wide-awake local anesthesia in an office setting. Their results revealed a remarkable absence of deep infections, with only five superficial infections, all of which were successfully treated with oral antibiotics. Patient satisfaction was notably high; 95% of participants rated their experience as favorable or superior to a dental visit, and nearly all were willing to repeat the choice of local anesthesia and recommend it to others [ 48 ]. Furthermore, LeBlanc et al. [ 49 ] reported that using a less strict sterility protocol approach for carpal tunnel release (CTR) led to a minimal rate of superficial infections (.40%) and no deep infections. This method, which eliminated the need for gowns and prophylactic antibiotics while maintaining essential sterile practices, was shown to be more than twice as time-efficient and reduced costs by 73% compared with traditional OR settings [ 49 ]. A subsequent analysis by Silver and Lalonde [ 50 ] confirmed these findings, indicating that performing open CTR in a procedure room was 32% less expensive than that in an OR without compromising pain management, patient satisfaction, or infection rates [ 50 ]. Finally, Rhee et al. reported substantial financial benefits, noting an 85% cost reduction when using wide-awake local anesthesia with no tourniquet for CTR in a procedure room instead of an OR [ 51 ]. In alignment with Ingram [ 52 ], these findings collectively highlight the potential of office-based procedure rooms to deliver safe, efficient, and economically advantageous alternatives to traditional surgical environments, particularly for procedures such as CTR. 5. Conclusion Our systematic review identified several issues in the literature that must be addressed. First, the procedural setting for the USG-CTR was underreported. The lack of specific reporting on where the USG-CTR was performed made it challenging to categorize and compare the outcomes of interest based on the setting. Our inclusion criteria required studies to explicitly describe the procedure setting. Studies that did not provide this information were excluded because of the reduced number of eligible studies for analysis. Second, our systematic review identified a new challenge when data from interventional radiology settings were integrated into the comparison of the outcomes of interest. While the differences between PRs and ORs are clear, IR settings fall between ORs and PRs in terms of invasiveness and risk assessment, and more clarity is needed to accurately categorize and compare outcomes based on these settings. We also identified the need for more standardized reporting because of considerable variability in the measurement tools used to assess patient satisfaction, hand functionality, and symptomatology. In our review, studies using Disabilities of the Arm, Shoulder, and Hand (DASH) or the QuickDASH instead of the BCTQ for self-reported hand function and symptomatology outcomes were excluded. Unlike the above, we specifically focused on the BCTQ because it is a validated questionnaire that was specifically developed to measure the outcomes of CTS treatments [ 20 , 21 ]. Moreover, inconsistencies in the measurement tools for patient satisfaction were detected, indicating the need for more standardized assessment tools to facilitate direct and accurate comparisons of USG-CTR outcomes in future research. Finally, our study highlights a significant gap in the literature: the lack of research on the effects of different USG-CTR procedure settings on patient satisfaction, hand function, and symptomatology. This gap not only highlights a key strength of our study but also emphasizes the need for further research in this area. Our systematic review has several limitations. First, the review included a small number of studies, many of which were of low quality or had a high risk of bias, further constraining the strength of the conclusions. The reliance on case series, which are inherently limited by their observational nature and potential for bias, affects the overall reliability of the review findings. Second, the limited research experience of the two main peer reviewers posed challenges to the level of agreement for study inclusion, as evidenced by a small Cohen’s [ 28 ] kappa coefficient of .26. In addition, bias assessment and data extraction were conducted only by the author. To improve interrater reliability and reduce the risk of error, future systematic reviews could be conducted by multiple independent reviewers who should resolve disagreements on the basis of a clearer and more rigorous protocol. Third, considering the high heterogeneity of the data extracted, as well as the quality of the reported data in the selected literature, no higher-level statistical analyses were performed. Future systematic reviews could address this issue to draw more definitive conclusions about the comparative effectiveness of USG-CTR across different settings. Finally, factors such as sample size (Table 3 ), SD (Table 4 ), risk of bias (Table 2 ), USG-CTR technique, mean age, sex distribution (Table 5 ) and severity grading of the CTS from each study were not considered because of the high heterogeneity of the data extracted, which posed difficulties in comparing outcomes directly for an accurate assessment of the overall effectiveness of USG-CTR. After encountering the aforementioned challenges during our systematic review, we have provided several recommendations for future research. It is important to standardize the reporting of outcomes to enable more accurate and reliable comparisons across studies. Future research should focus on using standardized assessment tools to measure patient satisfaction, hand functionality, and symptomatology. There is a need for consensus on whether interventional radiology rooms should be considered separately or integrated into the operating room or procedure room setting. Additionally, further studies are needed to explore the long-term outcomes of the USG-CTR and to investigate the impact of different procedural settings on patient satisfaction and functional recovery. Addressing these gaps in the literature will lead to a more comprehensive understanding of the optimal settings for performing USG-CTR. In conclusion, this systematic review highlights the significant potential of ultrasound-guided carpal tunnel release as an effective treatment for carpal tunnel syndrome when performed in procedure and interventional radiology rooms compared with traditional operating rooms. The present findings support a high level of patient satisfaction and substantial improvements in hand function and symptom relief associated with the USG-CTR, most likely because of the minimally invasive nature of the procedure coupled with the precision of ultrasound guidance. Furthermore performing a USG-CTR in PR and IR settings provides, in addition to potentially improving patient satisfaction and hand function and symptomatology, substantial cost savings and operational efficiency. Future research should focus on reporting the outcomes of interest in a more standardized and rigorous way, as well as on further assessing the impact of different procedural settings on the effectiveness and accessibility of the USG-CTR. Abbreviations BCTQ: Boston Carpal Tunnel Questionnaire CAC: Critical Appraisal Checklist CENTRAL: Cochrane Central Register of Controlled Trials CTS: Carpal Tunnel Syndrome FSS: Functional Status Scale IR: Interventional Radiology Room JBI: Joanna Briggs Institute MCID: Minimal Clinically Important Difference MDC: Minimal Detectable Change OR: Operating Room PR: Procedure Room RCT: Randomized Controlled Trial SD: Standard Deviation SSS: Symptom Severity Scale TCL: Transverse Carpal Ligament USG-CTR: Ultrasound-Guided Carpal Tunnel Release VAS: Visual Analog Scale Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials All data analyzed during this study are included in this published article. The data were extracted from previously published studies, which are cited in the reference list. Registration and protocol This systematic review was not prospectively registered in a public database. A review protocol was developed and submitted as part of a Master of Surgery (ChM) dissertation at the University of Edinburgh but was not publicly accessible. No methodological amendments were made to the original protocol. Minor editorial modifications, including refinement of the title, were introduced during manuscript preparation. Competing interests The authors declare that they have no competing interests Funding Not applicable Acknowledgments The author would like to thank: Dr. Chantelle Aftab, BSc, MSc, PhD, Senior Lecturer and Deputy Programme Director, ChM Trauma and Orthopaedics, University of Edinburgh, for assistance in planning and organizing the project. Marshall Dozier, MA, PgDipLIS, EdD, FHEA, Academic Support Librarian (Medicine), University of Edinburgh, for assistance with the database search strategy and digital support. Andreea-Elena Ibanescu, Cognitive-Behavioral Coach Advisor, for support in planning and organization of the project. Dr. Ioana Teodora Neagoie, Orthopedics and Trauma Consultant, for peer review at the title and abstract screening and full-text screening stages. Authors' contributions O.D.D. contributed to conceptualization, study design, literature search and data extraction, screening, data analysis, interpretation of results, manuscript drafting, and final editing. C.S. contributed to study supervision, methodological guidance, conflict resolution during screening, critical revision of the manuscript, and approval of the final version. All authors read and approved the final manuscript. Authors’ information Oana Diana Damian is an Orthopedic Registrar in Ireland with previous clinical experience in outpatient musculoskeletal care in a regional hospital in Romania. Her academic interests include minimally invasive orthopedic procedures and the optimization of surgical care in ambulatory settings. References Lewis C, Mauffrey C, Newman S, Lambert A, Hull P. Current concepts in carpal tunnel syndrome: a review of the literature. Eur J Orthop Surg Traumatol. 2010;20(6):445–52. 10.1007/s00590-010-0585-9 . Azar FM, Canale ST, Beatty JH, editors. Campbell’s operative orthopaedics. 14th ed. Philadelphia: Elsevier; 2021. pp. 3857–e38844. Hidayati HB, Subadi I, Fidiana F, Puspamaniar VA. Current diagnosis and management of carpal tunnel syndrome: a review. Anaesth Pain Intensive Care. 2022;26(3):394–404. 10.35975/apic.v26i3.1902 . Núñez-Cortés R, Espin A, Pérez-Alenda S, López-Bueno R, Cruz-Montecinos C, Vincents-Seeberg KG et al. (2023) Association between pain coping and symptoms of anxiety and depression and work absenteeism in people with upper limb musculoskeletal disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2023;105(4):781-9. 10.1016/j.apmr.2023.07.003 Foley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State. Am J Ind Med. 2007;50:155–72. 10.1002/ajim.20430 . Hidayati HB, Subadi I, Fidiana F, Puspamaniar VA. Current diagnosis and management of carpal tunnel syndrome: a review. Anaesth Pain Intensive Care. 2022;26(3):394–404. 10.35975/apic.v26i3.1902 . de la Fuente J, Aramendi JF, Ibanez JM, Blasi M, Vazquez A, Aurrekoetxea JJ. Minimally invasive ultrasound-guided vs open release for carpal tunnel syndrome in working population: a randomized controlled trial. J Clin Ultrasound. 2021;49(7):693–703. 10.1002/jcu.23019 . Eberlin KR, Amis BP, Berkbigler TP, Dy CJ, Fischer MD, Gluck JL. Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique. Expert Rev Med Devices. 2023;20(7):597–605. 10.1080/17434440.2023.2218548 . Eberlin KR, Dy CJ, Fischer MD, Gluck JL, Kaplan FTD, McDonald TJ. Trial of ultrasound guided carpal tunnel release versus traditional open release (TUTOR). Medicine. 2022;101(41):e30775. 10.1097/MD.0000000000030775 . Randall DJ, et al. Moving minor hand surgeries out of the operating room and into the office-based procedure room: a population-based trend analysis. J Hand Surg Am. 2022;47(12):1137–45. 10.1016/j.jhsa.2022.08.026 . Asserson DB, North TJ, Rhee PC, Bishop AT, Brault JS, Shin AY. Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study. J Hand Surg Eur Vol. 2022;47(4):359–63. 10.1177/17531934211051276 . Bergum RA, Ciota MR. Office-based carpal tunnel release using ultrasound guidance in a community setting: long-term results. Cureus. 2022;14(7):e27169. 10.7759/cureus.27169 . Croutzet P, Guinand R, Djerbi I. Birth and growth of an ultrasound hand surgery center: a review of 1167 procedures. Ortho J Sports Med. 2019;7(5suppl3):2325967119S0021. 10.1177/2325967119S00216 . Cumpston M, Chandler J et al. Chapter II: planning a Cochrane review. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, editors. Cochrane handbook for systematic reviews of interventions (version 6.4). Cochrane; 2023. Cochrane Community. PICO search about. 2023. https://community.cochrane.org/pico-search-about . Accessed 30 Oct 2023. PRISMA. PRISMA 2020 flow diagram. 2024. https://www.prisma-statement.org/prisma-2020-flow-diagram Accessed 13 Jul 2024. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg. 1993;75(11):1585–92. 10.2106/00004623-199311000-00002 . Covidence. Covidence systematic review software. Veritas Health Innov. 2024. https://www.covidence.org/ Hayward C. Sizing imaging and procedure rooms. 2023. https://blog.spacemed.com/sizing-imaging-and-procedure-rooms/ . Accessed 17 Dec 2025. Jerosch-Herold C, Bland JDP, Horton M. Is it time to revisit the Boston Carpal Tunnel Questionnaire? New insights from a Rasch model analysis. Muscle Nerve. 2021;63(4):484–9. 10.1002/mus.27173 . Mehta SP, Weinstock-Zlotnick G, Akland KL, Hanna MM, Workman KJ. Using Carpal Tunnel Questionnaire in clinical practice: a systematic review of its measurement properties. J Hand Ther. 2020;33(4):493–506. 10.1016/j.jht.2019.12.011 . Joanna Briggs Institute. JBI critical appraisal checklist for randomized controlled trials. 2020. https://jbi.global/sites/default/files/2020-08/Checklist_for_RCTs.pdf Joanna Briggs Institute. JBI critical appraisal checklist for cohort studies. 2017. https://jbi.global/sites/default/files/2019-05/JBI_Cohort_Appraisal_tool2017_0.pdf Joanna Briggs Institute. JBI critical appraisal checklist for case series. 2017. https://jbi.global/sites/default/files/2019-05/JBI_Case_Series_Appraisal_tool2017_0.pdf Joanna Briggs Institute. JBI critical appraisal tools. 2020. https://jbi.global/critical-appraisal-tools Microsoft Corporation. Microsoft Excel. Microsoft 365. 2024. https://www.microsoft.com/en-us/microsoft-365/excel OpenAI. ChatGPT: data analysis, visualization, and ideation [Large language model]. 2024. https://chat.openai.com/ . Accessed 17 Dec 2025. Cohen J. A coefficient of agreement for nominal scales. Educat Psychol Measure. 1960;20(1):37–46. 10.1177/001316446002000104 . Kim IJ, Kim JM. Long-term outcomes of ultrasound-guided thread carpal tunnel release and its clinical effectiveness in severe carpal tunnel syndrome: a retrospective cohort study. J Clin Med. 2024;13(1). 10.3390/jcm13010262 . Guo D, Guo J, Schmidt SC, Lytie RM. A clinical study of the modified thread carpal tunnel release. Hand. 2017;12(5):453–60. 10.1177/1558944716668831 . Chern TC, Kuo LC, Shao CJ, Wu TT, Wu KC, Jou IM. Ultrasonographically guided percutaneous carpal tunnel release: early clinical experiences and outcomes. Arthroscopy. 2015;31(12):2400–10. 10.1016/j.arthro.2015.06.023 . Petrover D, Silvera J, De Baere T, Vigan M, Hakimé A. Percutaneous ultrasound-guided carpal tunnel release: study upon clinical efficacy and safety. Cardiovasc Intervent Radiol. 2017;40(4):568–75. 10.1007/s00270-016-1545-5 . Mende K, Kamphuis SJM, Schmid V, Schaefer DJ, Kaempfen A, Gohritz A. Early postoperative recovery after modified ultra-minimally invasive sonography-guided thread carpal tunnel release. J Pers Med. 2023;13(4). 10.3390/jpm13040610 . Kamel SI, Freid B, Pomeranz C, Halpern EJ, Nazarian LN. Minimally invasive ultrasound-guided carpal tunnel release improves long-term clinical outcomes in carpal tunnel syndrome. Am J Roentgenol. 2021;217(2):460–8. 10.2214/AJR.20.24383 . Chappell CD, Beckman JP, Baird BC, Takke AV. Ultrasound (US) changes in the median nerve cross-sectional area after microinvasive US-guided carpal tunnel release. J Ultrasound Med. 2020;39(4):693–702. 10.1002/jum.15146 . Bland JDP. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 2000;23(9):1280–83. 10.1002/1097-4598(200009)23 . Moscato L, Helmi A, Kouyoumdjian P, Lalonde D, Mares O. The impact of WALANT anesthesia and office-based settings on patient satisfaction after carpal tunnel release: a patient reported outcome study. Orthop Traumatol Surg Res. 2023;109(3):103134. 10.1016/j.otsr.2021.103134 . Cano LC, et al. Clinical results of carpal tunnel release using ultrasound guidance in over 100 patients at two to six years. J Hand Surg Glob Online. 2024;6(3):354–9. 10.1016/j.jhsg.2024.03.004 . Aguila D, et al. Long-term clinical results of carpal tunnel release using ultrasound guidance: a multicenter pragmatic study. J Hand Surg Glob Online. 2024;6(1):79–84. 10.1016/j.jhsg.2023.11.002 . Wise A, Pourcho AM, Henning PT, Latzka EW. Evidence for ultrasound-guided carpal tunnel release. Curr Phys Med Rehabil Rep. 2021;9(1):11–22. 10.1007/s40141-020-00305-0 . Hall MM, Kliethermes SA, Henning PT, Hoffman DF, Mautner K, Obunadike E, et al. Three-month complication rate of ultrasound-guided soft tissue surgical procedures across six sports medicine clinics. J Ultrasound Med. 2023;42(11):2629–41. https://dx.doi.org/10.1002/jum.16298 . Benson LS, Bare AA, Nagle DJ, Harder VS, Williams CS, Visotsky JL. Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006;22(9):919–e242. 10.1016/j.arthro.2006.05.008 . Apard T, Candelier G. Surgical ultrasound-guided carpal tunnel release. Hand Surg Rehabil. 2017;36(5):333–7. https://dx.doi.org/10.1016/j.hansur.2017.05.005 . Lam KHS, Wu Y-T, Reeves KD, Galluccio F, Allam AE-S, Peng PWH. Ultrasound-guided interventions for carpal tunnel syndrome: a systematic review and meta-analyses. Diagnostics. 2023;13(6):1138. 10.3390/diagnostics13061138 . Burnham RS, Loh EY, Rambaransingh B, Roberts SL, Agur AM, Playfair LD. A controlled trial evaluating the safety and effectiveness of ultrasound-guided looped thread carpal tunnel release. Hand (N Y). 2021;16(1):73–80. 10.1177/1558944719842199 . Vasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP, Brassington R, Scholten RJP, et al. Endoscopic and open release similarly safe for the treatment of carpal tunnel syndrome. a systematic review and meta-analysis. PLoS ONE. 2015;10(12):e0143683. 10.1371/journal.pone.0143683 . Ohuchi H, Hattori S, Shinga K, Ichikawa K, Yamada S. Ultrasound-assisted endoscopic carpal tunnel release. ArthroscTech. 2016;5(3):e483–87. 10.1016/j.eats.2016.01.035 . Van Demark RE, Becker HA, Anderson MC, Smith VJS. Wide-awake anesthesia in the in-office procedure room: lessons learned. Hand (N Y). 2018;13(4):481–5. 10.1177/1558944717715120 . LeBlanc MR, Lalonde DH, Thoma A, Bell M, Wells N, Allen M, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y). 2011;6(1):60–3. 10.1007/s11552-010-9301-9 . Silver N, Lalonde DH. Main operating room versus field sterility in hand surgery: a review of the evidence. Plast Surg (Oakv). 2023;32(4):627–37. 10.1177/22925503231161073 . Rhee PCDOMS, Fischer MM, Rhee LSDOMHA, McMillan H, Johnson AEMD. Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg (Am). 2017;42(3):e139–47. 10.1016/j.jhsa.2016.11.019 . Ingram J, Mauck BM, Thompson NB, Calandruccio JH. Cost, value, and patient satisfaction in carpal tunnel surgery. Orthop Clin North Am. 2018;49(4):503–7. 10.1016/j.ocl.2018.06.005 . Additional Declarations No competing interests reported. Supplementary Files PRISMA2020checklistcompleted.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 31 Mar, 2026 Editor assigned by journal 02 Mar, 2026 Submission checks completed at journal 02 Mar, 2026 First submitted to journal 25 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8968369","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":621045612,"identity":"71fb9741-61b9-42b0-ad98-3c105c55ebba","order_by":0,"name":"Oana Diana Damian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIie3PMQuCQBTA8TsObCnnJKKvkEstRl9FEZy67xAE11J7TX2FB4HVdiLUkOAquDQ5JegSNQSptFVaW8P9OXjL/Xg8hESif4wXL4/siyHVvieShZCeDfIFeVbvFQRVEflwNPhtq3X6Ne9ySq92RyYIJ+noM1E8Cs7cs9TdjG7UhR6qjCCiLO3PpMsp8AZzMXBqt+p6iDMikUYZ8WNw7swdgn+OcjKsJgEFN9tiQDCScmJUEiWIwW0zy4Qg6ikLKzQZwZPSW2SfrtOYaQPwzaiZaOFgNZ04SVpC3oXHv/0XiUQi0UsP/zpZFKngvPUAAAAASUVORK5CYII=","orcid":"","institution":"University of Edinburgh","correspondingAuthor":true,"prefix":"","firstName":"Oana","middleName":"Diana","lastName":"Damian","suffix":""},{"id":621045613,"identity":"05f087d3-361e-4d08-8d47-187f23f160cd","order_by":1,"name":"Claire Simpson","email":"","orcid":"","institution":"University of Edinburgh","correspondingAuthor":false,"prefix":"","firstName":"Claire","middleName":"","lastName":"Simpson","suffix":""}],"badges":[],"createdAt":"2026-02-25 13:38:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8968369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8968369/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108819664,"identity":"bbaa5498-cc5e-4ed3-9e42-7cc561f87937","added_by":"auto","created_at":"2026-05-08 16:38:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":494833,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8968369/v1/07403bbe8918bd162d85f426.png"},{"id":108819126,"identity":"156ebd61-f06a-40ae-bbfb-8ddc58408c4d","added_by":"auto","created_at":"2026-05-08 16:36:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":118608,"visible":true,"origin":"","legend":"\u003cp\u003eMean Average BCTQ-FSS and BCTQ-SSS Scores Across Different Settings Over Time.\u003c/p\u003e\n\u003cp\u003eNote: FSS (Boston Carpal Tunnel Questionnaire-Functional Status Scale) and SSS (Boston Carpal Tunnel Questionnaire-Symptom Severity Scale) scores were measured for operating(OR), procedure(PR), and interventional radiology rooms (IR). Data sourced from studies conducted by Bergum et al. [12], Chern et al. [31], Guo et al. [30], Kamel et al. [34], and Petrover et al. [32].\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8968369/v1/1d42eea35ca65d91b1b30308.png"},{"id":108819497,"identity":"d16b8f65-713b-4320-903c-1dc594d06dd7","added_by":"auto","created_at":"2026-05-08 16:37:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49831,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8968369/v1/03e0777609902ad340955e62.png"},{"id":108822336,"identity":"18eb9048-db78-4ba5-8d4e-b8f9c7975882","added_by":"auto","created_at":"2026-05-08 16:48:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1128260,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8968369/v1/1a98300b-8e3b-4d1a-8c80-bcf8811fca93.pdf"},{"id":108819123,"identity":"169734cc-7166-4173-9ce8-d87ad1de25c2","added_by":"auto","created_at":"2026-05-08 16:36:14","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":216057,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMA2020checklistcompleted.docx","url":"https://assets-eu.researchsquare.com/files/rs-8968369/v1/c543febc31e081141105dadf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ultrasound-guided carpal tunnel release outside the operating theatre. Patient satisfaction, hand function, and symptomatology. A systematic review. ","fulltext":[{"header":"1. Background","content":"\u003cp\u003eCarpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the carpal tunnel level. It is diagnosed mainly through medical history and clinical examination. Neurophysiological testing confirms the diagnosis and grades the severity of the neuropathy. CTS commonly occurs between 30 and 60 years of age, with a reported incidence of 6% in the general population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], and it is up to 3 times more common in females [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe impact of this pathology is seen at both the socioeconomic and individual levels, affecting the patient's quality of life. CTS symptomatology can affect one's ability to perform daily activities, resulting in medical leave, sleep disturbances, and psychological stress [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The economic impact of the pathology is based on the health care cost incurred and the patient's cumulative loss of income. According to a study conducted in the USA, patients with CTS experience a loss in income of \u003cspan\u003e$\u003c/span\u003e45,000\u0026ndash;\u003cspan\u003e$\u003c/span\u003e89,000 over 6 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFor patients with mild symptoms, management with medications and splints may be an option. Surgical decompression of the median nerve by division of the transverse carpal ligament (TCL) is reserved for patients with severe symptoms, including sensory or motor impairment, and those with refractory symptoms of more than six months.\u003c/p\u003e \u003cp\u003eBoth open and endoscopic techniques can achieve surgical decompression of the carpal tunnel [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, a new carpal tunnel release (CTR) technique has recently emerged. Ultrasound-CTR (USG-CTR) has gained popularity and interest in the literature [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This innovative procedure, which can be carried out without an incision using an abrasive thread, a needle, a hook blade, or a specialized device such as UltraGuideCTR\u0026trade; (Sonex Heath, Inc., Eagan, MN, USA), offers a promising future for CTS treatment. The procedure can be performed under local or general anesthesia in an ambulatory or operating room setting. Additionally, to the best of our knowledge, the literature shows comparable safety and effectiveness between open and ultrasound-guided techniques [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConsidering the impact of carpal tunnel syndrome (CTS) on affected individuals, the growing clinical interest in USG-CTR as a treatment option, and the increasing tendency to perform carpal tunnel release in outpatient settings [\u003cspan additionalcitationids=\"CR8 CR9 CR10 CR11 CR12\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], we conducted a search on the PROSPERO platform to find ongoing systematic reviews that assess patient satisfaction, symptomatology, and hand function following USG-CTR in both operating room (OR) and procedure room (PR) settings. However, no results were found, signaling a gap in the literature.\u003c/p\u003e \u003cp\u003ePerforming this intervention outside the operating theatre could lower hospitalization costs and open more hours for the operating theatre. Conversely, unclear barriers might hinder clinicians from making the PR setting a standard-setting option for the USG-CTR [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As such, this systematic review of the USG-CTR may offer preliminary evidence supporting USG-CTR office-based treatment as an effective option.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Study aim and hypothesis\u003c/h2\u003e \u003cp\u003eThis study aims to investigate the literature on the USG-CTR to determine to what extent it may be an effective option for procedure room treatment in terms of global patient satisfaction, hand function, and symptomatology.\u003c/p\u003e \u003cp\u003eWe hypothesized that USG-CTR conducted in procedure rooms would yield the same or higher patient satisfaction and the same improvement in hand symptomatology and function as those conducted in an operating room.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methodology [14]","content":" \u003cp\u003eThis systematic review is based on the PICO framework [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] to meticulously structure the methodology for evaluating the effectiveness of the USG-CTR as a therapeutic intervention for CTS. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the detailed PICO framework employed in our study, delineating the patient population, intervention, comparison, and outcomes, with the addition of the study design. This structured approach facilitates a comprehensive and systematic assessment of the effectiveness of the USG-CTR in treating CTS, ensuring a rigorous analysis of the relevant literature.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePICO Framework\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients who underwent carpal tunnel release\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrasound-guided carpal tunnel release in procedure room setting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComparator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUltrasound-guided carpal tunnel release in operating room setting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient satisfaction and hand function and symptomatology scores\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystematic reviews, RCTs, cohort studies, pro/retrospective studies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAdditionally, in our study, we used a PRISMA flow diagram (Fig.\u0026nbsp;1), to show how the studies were selected. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram is a tool that helps visualize each step of the review process. It outlines how many records were identified, screened, included, and excluded, along with the reasons for exclusions [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].This systematic review was reported in accordance with the PRISMA 2020 statement (completed PRISMA 2020 checklist provided in Additional file 1).\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Databases and search strategy\u003c/h2\u003e \u003cp\u003eFour databases\u0026mdash;Ovid EMBASE, Ovid MEDLINE, CENTRAL, and Scopus\u0026mdash;were searched to identify relevant literature from their inception to May 6th, 2024. The search strategy included the terms \u0026ldquo;carpal tunnel release\u0026rdquo; OR \u0026ldquo;carpal tunnel decompression\u0026rdquo; AND \u0026ldquo;guided\u0026rdquo; AND \u0026ldquo;ultrasound\u0026rdquo; OR \u0026ldquo;echography\u0026rdquo; OR \u0026ldquo;sonography\u0026rdquo;. A single reviewer performed the literature search without imposing any restrictions. A manual search of the articles' references for additional relevant studies was not conducted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Study inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were as follows: 1) English-language systematic reviews of randomized controlled trials (RCTs), pragmatic cohort studies, retrospective and prospective studies, cohort studies, and case series studies in humans that assess the outcomes of USG-CTR for CTS; 2) studies that precisely specify the setting where the USG-CTR intervention took place: operating room (OR), procedure room (PR), or interventional radiology room (IR); 3) studies that measured the outcomes of interest using standardized questionnaires, namely, the visual analog scale (VAS) (self-reported, interviewer-administered by telephone or email/web-based), for assessing patient satisfaction and the Boston Carpal Tunnel Questionnaire (BCTQ) for assessing hand function and symptomatology [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: 1) cadaveric studies, ongoing studies, preliminary results studies, and studies for which full-text retrieval was impossible; 2) studies with mixed specified intervention settings that did not present the outcome for the operating and procedure room interventions separately.\u003c/p\u003e \u003cp\u003eTwo independent reviewers screened the title and abstract and performed the full-text review using the web-based collaboration software platform Covidence [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The third reviewer, the supervisor of the systematic review, acted as a mediator and final decision-maker in resolving the conflicts at the abstract review level.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Data extraction\u003c/h2\u003e \u003cp\u003eData extraction was performed by the first author using Covidence. Several aspects were considered before beginning the process:\u003c/p\u003e \u003cp\u003eFirst, the classification of IR facilities consists of 3 classes. Class 1 does not require the same environmental control as PRs and is used as an examination/procedure room. Class 2 does not require the same environmental control as ORs and is used for minimally invasive procedures. Class 3 has the same status as an OR [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, IRs fall between ORs and PRs in terms of invasiveness and risk assessment, depending on their classification. Additionally, a PR requires a different level of environmental control compared with a Class 2 IR [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this review, in cases where the status of the IR is not specified, we coded it as an OR setting.\u003c/p\u003e \u003cp\u003eAnother essential aspect considered during the data extraction was to focus on both components of BCTQ, namely, the functional status score (FSS) and symptom severity score (SSS), rather than on the overall BCTQ score. This decision was based on recent research indicating that the overall score of the BCTQ is not psychometrically valid and that the questionnaire's subscales should be used for interpreting data [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the end, the collected data included study identification details, start and end dates of the study, type of study, inclusion and exclusion criteria, hand and participant sample size, number and reason for withdrawals, intervention setting, patient satisfaction based on VAS or other standardized questionnaires, and hand symptomatology and function based on the BCTQ-SSS and BCTQ-FSS scores measured preoperatively and at 3 months, 6 months, and 1 year of follow-up. Hand side and hand dominance were not considered.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Bias assessment\u003c/h2\u003e \u003cp\u003eIn this review, the Joanna Biggs Institute (JBI) Critical Appraisal Checklist (CAC) was used to evaluate the risk of bias. Given the limited research experience of the authors, this checklist was chosen because it provides detailed guidance for each question assessing various domains of different types of studies [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In addition, according to the official JBI site, peer reviews have extensively validated the checklist [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe authors assessed the risk of bias for the included studies using the JBI CAC for case series [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], cohort studies [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and RCTs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. To deem the overall risk of bias low, 7 of the 10 domains on the JBI-CAC for Case Series, 8 of the 11 domains on the JBI-CAC for cohort studies, and 10 of the 13 domains on the JBI-CAC for RCTs had to be appraised as \u0026ldquo;YES.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Software tools and study analysis\u003c/h2\u003e \u003cp\u003eIn this research, three software tools were used to facilitate data analysis and visualization. Microsoft Excel, which is part of the Microsoft 365 suite [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], was used for data organization and advanced analysis, while OpenAI ChatGPT [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] was employed for computing descriptive statistics and for generating tables and graphs to support interpretation and analysis.\u003c/p\u003e \u003cp\u003eFurthermore, Covidence [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], a web-based collaboration software platform that streamlines the production of systematic and other literature reviews, was used. This tool was instrumental in generating a PRISMA flow diagram.\u003c/p\u003e \u003cp\u003eCovidence [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] was also used to calculate Cohen's kappa coefficient [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], which assesses the level of agreement between reviewers and measures the reliability level of the review process.\u003c/p\u003e \u003cp\u003eFinally, the descriptive analysis of the case series was conducted separately from the descriptive analysis of the RCT and cohort studies. This approach allowed us to scrutinize the case series independently, ensuring a comprehensive understanding of its characteristics and implications. Effect measures used were mean difference (change from baseline) for BCTQ-FSS and BCTQ-SSS. No sensitivity analyses were conducted due to the limited number of included studies and the high heterogeneity of the extracted data. No formal assessment of reporting bias (e.g., funnel plot or small-study effects analysis) was performed due to the small number of included studies. No formal certainty of evidence assessment (e.g., GRADE approach) was conducted.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Study type and selection\u003c/h2\u003e \u003cp\u003eFrom the initial screening, 296 studies were imported into Covidence. We identified 4 duplicates manually and 154 duplicates using Covidence and marked 53 studies as ineligible with automation tools. Eighty-five studies were identified as potentially relevant for our study, of which 9 were ultimately included. The included studies comprised 1 RCT [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], 1 retrospective uncontrolled cohort study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], 4 prospective case series [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], 2 retrospective case series [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and 1 retrospective case series review of prospectively collected data [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Figure\u0026nbsp;1 provides a step-by-step breakdown of the review process.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Bias analysis\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the critical appraisal of the 7-case series [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] included in the study. On the basis of the JBI CAC for case series [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], 3 of the 7 case series studies had a low risk of bias, while the remaining studies had a high risk of bias. RCTs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] were found to have a high risk of bias, with 8 out of 13 domains assessed as \u0026ldquo;YES.\u0026rdquo; The included retrospective uncontrolled cohort study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] was found to have a low risk of bias, with 9 out of 11 domains assessed as \u0026ldquo;YES.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCritical Appraisal of the 7-Case Series Included in the Systematic Review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChappell et al. 2020 [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePetrover et al. 2017 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGuo et al. 2017 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKamel et al. 2021 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eChern et al. 2015 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMende et al. 2023 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBergum et al. 2022 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplete Inclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondition Measure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsecutive Inclusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMethods Used for Condition Identification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome or Follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants' Clinical Information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants' Demographics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSite/Clinic(s) Demographics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatistical Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e% Risk of Bias\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: The table shows the critical appraisal of the 7-case series included in the study on the basis of the JBI CAC for case series [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In this table, \"1\" indicates \"Yes\", \"0\" indicates \"No\", and \"U\" indicates \"Unclear\".\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Study characteristics and design\u003c/h2\u003e \u003cp\u003eDifferent approaches for measuring the outcomes of interest have been identified in the selected literature. Specifically, the RCT [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] included in the review investigated the clinical effectiveness of minimally invasive USG-CTR vs. open release for treating CTS. However, the FSS and SSS scores differed only between the USG-CTR and open carpal tunnel release surgery; consequently, comparisons with other studies were impossible. A cohort study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] aimed to investigate the long-term outcomes and clinical effectiveness of USG-CTR by thread dissection in severe CTS. This study compared the severity of 2 groups of CTS, which were graded using Bland's classification [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Neither the RCT nor the cohort study included patient satisfaction as an outcome of interest.\u003c/p\u003e \u003cp\u003eIn 7 case series [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], the feasibility, safety, and short-term or long-term clinical outcomes of existing, new, or modified USG-CTR techniques were presented. Two studies were performed in an interventional radiology room (IR) [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], 4 in a procedure room (PR) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and 1 in an operating room (OR) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Only two studies, those by Mende et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], included patient satisfaction outcomes. Mende et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] used a visual analog scale (VAS) ranging from 0 to 10 to assess patient satisfaction. However, the data presented were unclear and incomplete\u0026mdash;no baseline scores for patient satisfaction were reported. Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] employed a 5-point global satisfaction metric to score patient experiences. The scale ranged from 1\u0026thinsp;=\u0026thinsp;very dissatisfied to 5\u0026thinsp;=\u0026thinsp;very satisfied. Their findings revealed that 83% (38 out of 46) of the patients expressed satisfaction or extreme satisfaction with the procedure at the 2-week follow-up. This satisfaction rate increased to 93% (37 out of 40) during long-term follow-up. Furthermore, the authors reported a statistically significant moderate inverse correlation between patient satisfaction and the BCTSQ score at the long-term follow-up [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, it is unclear whether the long-term follow-up was the same as the maximum 1-year follow-up reported for the BCTQ.\u003c/p\u003e \u003cp\u003eAll the case series studies except those by Mende et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] provided clear data for the BCTQ FSS and SSS outcomes. One study [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] provided incomplete descriptive statistics, with the standard deviation (SD) for the FSS and SSS scores missing. Chappell et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] reported the outcome of interest 6\u0026ndash;10 weeks after surgery, which is less than 3 months, making it unsuitable for our analysis.\u003c/p\u003e \u003cp\u003eFive studies [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported different follow-up periods. Only Chern et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] and Guo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] reported follow-up outcomes at 6 months and 1 year. Petrover et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] provided data at 6 months; Bergum et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] provided data at 1 year. All five studies conducted statistical analyses on hand sample sizes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Results analysis\u003c/h2\u003e \u003cp\u003eThe minimal detectable changes (MDC) at a 95% confidence interval considered in this review were .85 for SSS and .94 for FSS, in accordance with recent reports in the literature [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Furthermore, a minimal clinically important difference (MCID) of 1.05 for the SSS and 1.13 for the FSS was calculated from the reported baseline score [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, factors such as sample size (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), SD (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), risk of bias (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), USG-CTR technique, mean age, sex distribution (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) and severity grading of the CTS from each study were not considered because of the high heterogeneity of the data extracted.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHand Sample Size for BCTQ-FSS and BCTQ-SSS Over Time\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBergum et al., 2020 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChern et al., 2015 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuo et al., 2017 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKamel et al., 2021 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePetrover et al., 2017 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNote: BCTQ-FSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire Functional Status Scale; BCTQ-SSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire Symptom Severity Scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandard Deviation of BCTQ-FSS and BCTQ-SSS Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBergum et al., 2022 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChern et al., 2015 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuo et al., 2017 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKamel et al., 2021 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePetrover et al., 2017 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eNote: BCTQ-FSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire - Functional Status Scale; BCTQ-SSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire - Symptom Severity Scale. \u0026lsquo;n/a \u0026lsquo;data not available.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Equipment, Mean Age, and Sex Distribution\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEquipment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean Age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMales (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemales (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBergum et al., 2022 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevice*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChern et al., 2015 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHook knife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuo et al., 2017 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThread\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKamel et al., 2021 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDevice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePetrover et al., 2017 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHook knife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: Equipment refers to the instrument used in the technique to dissect the TCL. *Device: SX-One MicroKnife, Sonex Health Inc., Eagan, MN, USA.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.4.1. Case series analysis\u003c/h2\u003e \u003cp\u003eAs previously mentioned, 7 case series [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31 CR32 CR33 CR34\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] were considered in this review, of which only 5 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] were incorporated into the analysis. The exclusion of 2 studies was necessary for specific reasons. The study conducted by Chappell et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] was not included because it reported the outcome of interest at follow-ups of less than 3 months; therefore, it did not meet the criteria for this analysis. In addition, the study conducted by Mende et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] was excluded because of the provision of unclear and incomplete data, which would otherwise compromise the integrity of this analysis.\u003c/p\u003e \u003cp\u003eWhen the 5 included studies were analyzed, the hand samples reported by Chern et al. for the BCTQ-FSS and BCTQ-SSS outcomes were inconsistent and unclear [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The authors reported 91 hands postintervention and the loss of 3 hands at follow-up, resulting in 88 hands. However, the authors did not specify how they handled missing data during post hoc tests. A similar situation was encountered by Guo et al., who reported the most significant loss of hands at follow-up, from 159 hands at baseline to 41 hands at 1 year [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA comparative analysis of the means for BCTQ FSS and SSS outcomes, measured at baseline, 6 months, and 1 year, was conducted across the case series studies in diverse settings (IR, OR, and PR). The IR setting included the studies by Petrover et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], the OR setting included the study by Chern et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and the PR setting included the studies by Bergum et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and Guo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This comparison is visually represented in Tables\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e and \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and Fig.\u0026nbsp;2.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative Analysis of the Case Studies BCTQ FSS and SSS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBergum et al., 2022 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChern et al., 2015 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGuo et al., 2017 [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eKamel et al., 2021 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePetrover et al., 2017 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: IR\u0026thinsp;=\u0026thinsp;Interventional Radiology Room, OR\u0026thinsp;=\u0026thinsp;Operating Room, PR\u0026thinsp;=\u0026thinsp;Procedure Room; BCTQ-FSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire Functional Status Scale, BCTQ-SSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire Symptom Severity Scale; Baseline, 6 months, 1 year: Measurement time points for the outcomes.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Averages for IR and PR\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSetting\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 Months\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 Year\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: IR\u0026thinsp;=\u0026thinsp;Interventional Radiology Room; PR\u0026thinsp;=\u0026thinsp;Procedure Room; BCTQ-FSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire Functional Status Scale; BCTQ-SSS\u0026thinsp;=\u0026thinsp;Boston Carpal Tunnel Questionnaire Symptom Severity Scale; Baseline, 6 months; 1 year: Measurement time points for the outcomes.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure 2. Mean Average BCTQ-FSS and BCTQ-SSS Scores Across Different Settings Over Time.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003e\u003cdiv description=\"\" class=\"Drawing\" id=\"2\" name=\"Chart 1\"\u003e\u003c/div\u003eNote\u003c/strong\u003e \u003cp\u003eFSS (Boston Carpal Tunnel Questionnaire-Functional Status Scale) and SSS (Boston Carpal Tunnel Questionnaire-Symptom Severity Scale) scores were measured for operating (OR), procedure (PR), and interventional radiology rooms (IR). Data sourced from studies conducted by Bergum et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], Chern et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], Guo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and Petrover et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAt baseline, the FSS and SSS scores varied from 2.5 to 2.7 points and 2.7 to 3.3 points, respectively. The baseline reported score for the patients treated in the OR setting was 2.67 points for the FSS and 2.75 points for the SSS. The baseline scores for the FSS and SSS among OR, IR, and PR patients were not significantly different.\u003c/p\u003e \u003cp\u003eFurthermore, when the mean MA at baseline was computed for settings with a minimum of two studies, the IR setting patients exhibited an MA of 2.55 points for the FSS and 3.25 points for the SSS. Similarly, the PR setting demonstrated a mean average of 2.60 points for FSS and 3.12 points for SSS. These findings provided a comprehensive understanding of the BCTQ FSS and SSS baseline scores across different clinical settings, which we compare below.\u003c/p\u003e \u003cp\u003eThe IR and PR patients experienced the greatest significant changes in the SSS score at 6 months and 1 year. IR patients experienced a 2-point change at 6 months [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and a 2-point change at 1 year [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], whereas PR patients experienced a mean change of 1.84 points at 1 year. In the OR study, the patient SSS changed by 1.5 points at 6 months and 1.68 points at 1 year, and in the FSS, it changed by 1.37 points at 6 months and 1.6 points at 1 year.\u003c/p\u003e \u003cp\u003eWhen the FSS scores at the 1-year follow-up were compared, no distinct patterns emerged. Specifically, the study by Chern et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], conducted in an OR setting, was compared with the PR setting studies by Guo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and Bergum et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, the studies were compared with the IR setting study by Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. According to Chern et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], OR patients had the highest MCID (1.6 points). Conversely, among the four studies, Bergum et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] reported the lowest MCID, specifically 1.25 points.\u003c/p\u003e \u003cp\u003eOverall, this simple comparative analysis revealed that the improvements in FSS scores for the interventions conducted in the OR setting were similar to those from the IR and PR settings, with no notable differences detected. Similarly, the improvements in SSS scores for the interventions conducted in the PR and IR settings were comparable to those from the OR setting.\u003c/p\u003e \u003cp\u003eConversely, the IR and OR settings exhibited significantly greater variability compared with the PR setting after calculating a weighted average of the SD for BCTQ FSS and SSS. Specifically, the IR setting had a noticeably higher weighted average SD than did both the OR and PR settings. Notably, the OR setting included only one study, as Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] did not provide SD values, which led to the exclusion of their study from the analysis. Consequently, considering the limited data for the OR and IR setting, these findings should be interpreted with caution. A visual representation of the differences between the selected settings is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAll 5 case series studies demonstrated that the MDC and the MCID for the FSS and the SSS were consistently maintained above our set thresholds. Specifically, the MDC thresholds were .94 for FSS and .85 for SSS, whereas the MCID thresholds were 1.13 for FSS and 1.05 for SSS. These values were maintained at both the 6-month and 1-year follow-up points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.4.2 RCT and cohort study analysis\u003c/h2\u003e \u003cp\u003eThe RCT [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] data of interest, although reported as FSS and SSS, highlighted the significant differences between USG-CTR and open carpal tunnel release surgery without providing patients' FSS and SSS outcomes for each procedure. This lack of disaggregated data rendered the RCT unsuitable for inclusion in our analysis.\u003c/p\u003e \u003cp\u003eKim et al.'s retrospective cohort study aimed to investigate the long-term outcomes (over 2 years) of USG-CTR by the thread technique while concurrently assessing its clinical effectiveness in patients with severe CTS [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe USG-CTR was conducted in a PR setting, with patients demonstrating MCIDs of 2.09, 2.16, and 2.18 points at the 6-month, 1-year, and 2-year follow-ups, respectively, from a baseline of 3.21 SSS. In terms of the FSS score, the MCID was 1.24, 1.34, and 1.38 points at the 6-month, 1-year, and 2-year follow-ups, respectively, from a baseline of 2.42 points. A separate analysis was conducted on a subset of 21 hands out of the total 82 included in the study. The subset analysis aimed to evaluate the clinical effectiveness of the procedure in patients diagnosed with grade 6 CTS compared with those with grade 1\u0026ndash;5 CTS at the 6-month follow-up. CTS classification was based on neurophysiological results according to Bland\u0026rsquo;s grading system [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and reported as follows: very mild (grade 1), mild (grade 2), moderate (grade 3), severe (grade 4), very severe (grade 5), and extremely severe (grade 6) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Significant and more rapid improvements were observed in the FSS and SSS scores over 6 months for the CTS-grade 1\u0026ndash;5 patients than for the CTS-grade 6 patients. However, owing to the small number of grade 6 CTS hands included in the study, these results should be interpreted with caution. Further validation through additional research is necessary.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe primary objective of this systematic review was to investigate the effectiveness of the USG-CTR as a procedure room treatment option. This review specifically compared patient satisfaction, hand function, and symptomatology between USG-CTR performed in procedure rooms and operating rooms.\u003c/p\u003e \u003cp\u003eThis review revealed high levels of patient satisfaction with the use of the USG-CTR in both the PR and IR settings. For instance, Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] reported that 83% of patients were globally satisfied or extremely satisfied at 2 weeks, with this figure increasing to 93% at long-term follow-up. Mende et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] reported similar findings regarding treatment satisfaction, although their data were incomplete. While these studies report favorable patient satisfaction outcomes, the inconsistency in measurement tools (e.g., visual analog scales and numerical rating scales) and incomplete data undermine the reliability of these findings.\u003c/p\u003e \u003cp\u003eSignificant improvements in BCTQ-FSS and BCTQ-SSS were observed across various studies, indicating effective symptom relief and functional enhancement. For instance, Guo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], who conducted their procedure in a PR setting, reported a decrease in BCTQ-FSS from 2.56 to 1.11 and in BCTQ-SSS from 3.19 to 1.19 at the 1-year follow-up, which is above the MDC and MCID thresholds and shows statistically significant improvements. Conversely, the IR and OR settings exhibited significantly greater variability than the PR setting did after a weighted average of the SD for BCTQ FSS and SSS was calculated. Specifically, the IR setting had a noticeably higher weighted average SD than did both the OR and PR settings. Notably, the OR setting included only one study, as Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] did not provide SD values, which led to the exclusion of their study from the analysis. This exclusion affects the reliability of the comparison, as the variability assessment in the OR and IR settings is based on limited data. Therefore, these findings should be interpreted with caution.\u003c/p\u003e \u003cp\u003eThis positive trend was consistent across all five case series included in our comparative analysis, with the MDC and MCID remaining above the threshold at 6 months and 1 year. On the basis of the observed numbers, the improvements in FSS scores in the OR setting were similar to those in the IR and PR settings, showing no notable difference. Similarly, the improvements in SSS in the PR and IR settings were comparable to those in the OR setting, with no significant difference observed. It appears that the type of setting\u0026mdash;whether OR, IR, or PR\u0026mdash;does not make a noticeable difference in the observed improvements in FSS and SSS scores. Additionally, a cohort study by Kim et al. conducted in a PR setting demonstrated significant improvements in both the BCTQ-FSS and the BCTQ-SSS, regardless of CTS severity. However, the improvement rates varied across the severity groups over 6 months. Significant and more rapid improvements were observed in the FSS and SSS scores over 6 months for the CTS-grade 1\u0026ndash;5 patients than for the CTS-grade 6 patients. Taken together, this finding empirically supports our hypothesis that USG-CTR conducted outside the operating theatre provides the same hand function and symptomatology outcomes as USG-CTR conducted in the OR.\u003c/p\u003e \u003cp\u003eThe evidence for improvements in hand function and symptomatology is moderately strong, as supported by the results of multiple case series and one cohort study that demonstrated significant postprocedure improvements. However, the reliance on case series, along with variability in follow-up durations and reporting methods, limits the generalizability of these findings.\u003c/p\u003e \u003cp\u003eNevertheless, the findings of this systematic review highlight the potential effectiveness of USG-CTR within the broader context of the literature, particularly concerning the procedures\u0026mdash;IR, PR, and OR. While previous studies have focused predominantly on the clinical outcomes of USG-CTR, limited attention has been given to how the procedural setting affects patient satisfaction, hand function, and symptomatology.\u003c/p\u003e \u003cp\u003eStudies by Kamel et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and Mende et al. [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] reported high levels of patient satisfaction with the USG-CTR in outpatient settings, which aligns with the general trend in the literature. For instance, a retrospective observational case series by Moscato et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] examined patient satisfaction with a USG-CTR in office-based versus operating room (OR) settings and used a numerical analog scale from 0 (complete disappointment) to 10 (complete satisfaction) to collect patient-reported outcomes; the results revealed that satisfaction scores differed by only .50 points between the two settings, representing a statistically insignificant difference, with both studies demonstrating high levels of patient satisfaction. Despite the limitations of this study, it highlights the importance of patient-reported outcomes in different surgical settings and suggests a promising area for further research [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther studies that did not focus on the intervention setting have also reported high levels of satisfaction and increased hand function and symptomatology after USG-CTR. Cano et al. reported a 91.2% satisfaction rate at 46 months in 162 hands treated with USG-CTR in both OR and outpatient settings, without distinguishing between the settings [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Similarly, Aguila et al. reported an 87.7% satisfaction rate and a mean procedure recommendation score of 8.9 out of 10 in 300 patients, further supporting the positive outcomes associated with the USG-CTR [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe effectiveness of USG-CTR in terms of patient satisfaction and BCTQ scores can be attributed to its minimally invasive nature, which reduces tissue damage and promotes faster healing [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Moreover, ultrasound guidance enhances surgical precision, potentially reducing the risk of injury to surrounding structures and leading to fewer postoperative complications [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Hall et al., in their retrospective chart review study, reported a complication rate of 2.3% in 128 patients who underwent ultrasound-guided carpal tunnel release (USG-CTR), with two reported infections and one hematoma [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Their results were similar to those from a systematic review by Benson et al. [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], which showed a total complication rate of .2% for endoscopic carpal tunnel release (CTR) and .5% for open CTR. Benson et al. reported complications, including neuropraxia, major nerve injury, digital nerve injury, tendon injury, and arterial arch injury, in 22,327 cases of endoscopic CTR and 5,669 cases of open CTR [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. According to Apard and Candelier, their systematic review revealed no reports of iatrogenic arterial or nerve injuries or the occurrence of complex regional pain syndrome in the literature during UCTR procedures [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Overall, this set of evidence suggests similarly low complication risks postsurgery among open CTR, endoscopic CTR and USG-CTR.\u003c/p\u003e \u003cp\u003eMoreover, regarding the rates of incomplete release of the TCL with USG-CTR, Lam et al. [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] reported in their systematic review two cases of persistent symptoms related to incomplete TCL dissection using the loop thread approach, as documented by Burnham et al. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Additionally, Chern et al. reported one case of recurrent symptoms at the 2-year follow-up. During an ultrasound assessment, a hypertrophied TCL was identified, necessitating a second USG-CTR [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. According to a systematic review and meta-analysis conducted by Vasiliadis et al., when comparing open CTR and endoscopic CTR, the risk of incomplete release of the TCL is greater with endoscopic CTR because of the limited visualization of the surgical field. This limitation increases the risk of incomplete release compared with open CTR, which is considered the gold standard because of its direct visualization and lower risk of incomplete release [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Ohuchi et al. proposed a new ultrasound-assisted endoscopic CTR technique to reduce the risk of incomplete carpal tunnel release and minimize the risk of damage to the superficial palmar arch [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Although few studies have been conducted on USG-CTR because of its status as a new technique, this proposed hybridization of endoscopic CTR highlights the enhanced surgical precision provided by ultrasound guidance, potentially resulting in lower risks of complications after surgery. Surgeons, in particular, might benefit from incorporating USG into CTS surgical treatment to avoid postoperative complications.\u003c/p\u003e \u003cp\u003eWith respect to shifting minimally invasive surgeries to office-based procedure rooms, this approach offers a promising solution to ease the burden on traditional ORs. It could minimize costs, making it more convenient for patients and health care providers alike. Optimizing resource use ensures broader access to medical services while maintaining high standards of patient safety and satisfaction [\u003cspan additionalcitationids=\"CR49 CR50\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVan Demark et al. explored the outcomes of hand surgeries performed on 111 patients over 18 months using wide-awake local anesthesia in an office setting. Their results revealed a remarkable absence of deep infections, with only five superficial infections, all of which were successfully treated with oral antibiotics. Patient satisfaction was notably high; 95% of participants rated their experience as favorable or superior to a dental visit, and nearly all were willing to repeat the choice of local anesthesia and recommend it to others [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, LeBlanc et al. [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] reported that using a less strict sterility protocol approach for carpal tunnel release (CTR) led to a minimal rate of superficial infections (.40%) and no deep infections. This method, which eliminated the need for gowns and prophylactic antibiotics while maintaining essential sterile practices, was shown to be more than twice as time-efficient and reduced costs by 73% compared with traditional OR settings [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. A subsequent analysis by Silver and Lalonde [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] confirmed these findings, indicating that performing open CTR in a procedure room was 32% less expensive than that in an OR without compromising pain management, patient satisfaction, or infection rates [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinally, Rhee et al. reported substantial financial benefits, noting an 85% cost reduction when using wide-awake local anesthesia with no tourniquet for CTR in a procedure room instead of an OR [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. In alignment with Ingram [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], these findings collectively highlight the potential of office-based procedure rooms to deliver safe, efficient, and economically advantageous alternatives to traditional surgical environments, particularly for procedures such as CTR.\u003c/p\u003e"},{"header":"5. Conclusion","content":" \u003cp\u003eOur systematic review identified several issues in the literature that must be addressed. First, the procedural setting for the USG-CTR was underreported. The lack of specific reporting on where the USG-CTR was performed made it challenging to categorize and compare the outcomes of interest based on the setting. Our inclusion criteria required studies to explicitly describe the procedure setting. Studies that did not provide this information were excluded because of the reduced number of eligible studies for analysis. Second, our systematic review identified a new challenge when data from interventional radiology settings were integrated into the comparison of the outcomes of interest. While the differences between PRs and ORs are clear, IR settings fall between ORs and PRs in terms of invasiveness and risk assessment, and more clarity is needed to accurately categorize and compare outcomes based on these settings. We also identified the need for more standardized reporting because of considerable variability in the measurement tools used to assess patient satisfaction, hand functionality, and symptomatology. In our review, studies using Disabilities of the Arm, Shoulder, and Hand (DASH) or the QuickDASH instead of the BCTQ for self-reported hand function and symptomatology outcomes were excluded. Unlike the above, we specifically focused on the BCTQ because it is a validated questionnaire that was specifically developed to measure the outcomes of CTS treatments [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Moreover, inconsistencies in the measurement tools for patient satisfaction were detected, indicating the need for more standardized assessment tools to facilitate direct and accurate comparisons of USG-CTR outcomes in future research. Finally, our study highlights a significant gap in the literature: the lack of research on the effects of different USG-CTR procedure settings on patient satisfaction, hand function, and symptomatology. This gap not only highlights a key strength of our study but also emphasizes the need for further research in this area.\u003c/p\u003e \u003cp\u003e Our systematic review has several limitations. First, the review included a small number of studies, many of which were of low quality or had a high risk of bias, further constraining the strength of the conclusions. The reliance on case series, which are inherently limited by their observational nature and potential for bias, affects the overall reliability of the review findings. Second, the limited research experience of the two main peer reviewers posed challenges to the level of agreement for study inclusion, as evidenced by a small Cohen\u0026rsquo;s [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] kappa coefficient of .26. In addition, bias assessment and data extraction were conducted only by the author. To improve interrater reliability and reduce the risk of error, future systematic reviews could be conducted by multiple independent reviewers who should resolve disagreements on the basis of a clearer and more rigorous protocol. Third, considering the high heterogeneity of the data extracted, as well as the quality of the reported data in the selected literature, no higher-level statistical analyses were performed. Future systematic reviews could address this issue to draw more definitive conclusions about the comparative effectiveness of USG-CTR across different settings. Finally, factors such as sample size (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), SD (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), risk of bias (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), USG-CTR technique, mean age, sex distribution (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) and severity grading of the CTS from each study were not considered because of the high heterogeneity of the data extracted, which posed difficulties in comparing outcomes directly for an accurate assessment of the overall effectiveness of USG-CTR.\u003c/p\u003e \u003cp\u003e After encountering the aforementioned challenges during our systematic review, we have provided several recommendations for future research. It is important to standardize the reporting of outcomes to enable more accurate and reliable comparisons across studies. Future research should focus on using standardized assessment tools to measure patient satisfaction, hand functionality, and symptomatology. There is a need for consensus on whether interventional radiology rooms should be considered separately or integrated into the operating room or procedure room setting. Additionally, further studies are needed to explore the long-term outcomes of the USG-CTR and to investigate the impact of different procedural settings on patient satisfaction and functional recovery. Addressing these gaps in the literature will lead to a more comprehensive understanding of the optimal settings for performing USG-CTR.\u003c/p\u003e \u003cp\u003eIn conclusion, this systematic review highlights the significant potential of ultrasound-guided carpal tunnel release as an effective treatment for carpal tunnel syndrome when performed in procedure and interventional radiology rooms compared with traditional operating rooms. The present findings support a high level of patient satisfaction and substantial improvements in hand function and symptom relief associated with the USG-CTR, most likely because of the minimally invasive nature of the procedure coupled with the precision of ultrasound guidance. Furthermore performing a USG-CTR in PR and IR settings provides, in addition to potentially improving patient satisfaction and hand function and symptomatology, substantial cost savings and operational efficiency. Future research should focus on reporting the outcomes of interest in a more standardized and rigorous way, as well as on further assessing the impact of different procedural settings on the effectiveness and accessibility of the USG-CTR.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBCTQ: Boston Carpal Tunnel Questionnaire\u003c/p\u003e\n\u003cp\u003eCAC: Critical Appraisal Checklist\u003c/p\u003e\n\u003cp\u003eCENTRAL: Cochrane Central Register of Controlled Trials\u003c/p\u003e\n\u003cp\u003eCTS: Carpal Tunnel Syndrome\u003c/p\u003e\n\u003cp\u003eFSS: Functional Status Scale\u003c/p\u003e\n\u003cp\u003eIR: Interventional Radiology Room\u003c/p\u003e\n\u003cp\u003eJBI: Joanna Briggs Institute\u003c/p\u003e\n\u003cp\u003eMCID: Minimal Clinically Important Difference\u003c/p\u003e\n\u003cp\u003eMDC: Minimal Detectable Change\u003c/p\u003e\n\u003cp\u003eOR: Operating Room\u003c/p\u003e\n\u003cp\u003ePR: Procedure Room\u003c/p\u003e\n\u003cp\u003eRCT: Randomized Controlled Trial\u003c/p\u003e\n\u003cp\u003eSD: Standard Deviation\u003c/p\u003e\n\u003cp\u003eSSS: Symptom Severity Scale\u003c/p\u003e\n\u003cp\u003eTCL: Transverse Carpal Ligament\u003c/p\u003e\n\u003cp\u003eUSG-CTR: Ultrasound-Guided Carpal Tunnel Release\u003c/p\u003e\n\u003cp\u003eVAS: Visual Analog Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyzed during this study are included in this published article. The data were extracted from previously published studies, which are cited in the reference list.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration and protocol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis systematic review was not prospectively registered in a public database.\u003c/p\u003e\n\u003cp\u003eA review protocol was developed and submitted as part of a Master of Surgery (ChM) dissertation at the University of Edinburgh but was not publicly accessible.\u003c/p\u003e\n\u003cp\u003eNo methodological amendments were made to the original protocol. Minor editorial modifications, including refinement of the title, were introduced during manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to thank:\u003c/p\u003e\n\u003cp\u003eDr. Chantelle Aftab, BSc, MSc, PhD, Senior Lecturer and Deputy Programme Director, ChM Trauma and Orthopaedics, University of Edinburgh, for assistance in planning and organizing the project.\u003c/p\u003e\n\u003cp\u003eMarshall Dozier, MA, PgDipLIS, EdD, FHEA, Academic Support Librarian (Medicine), University of Edinburgh, for assistance with the database search strategy and digital support.\u003c/p\u003e\n\u003cp\u003eAndreea-Elena Ibanescu, Cognitive-Behavioral Coach Advisor, for support in planning and organization of the project.\u003c/p\u003e\n\u003cp\u003eDr. Ioana Teodora Neagoie, Orthopedics and Trauma Consultant, for peer review at the title and abstract screening and full-text screening stages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eO.D.D. contributed to conceptualization, study design, literature search and data extraction, screening, data analysis, interpretation of results, manuscript drafting, and final editing.\u003c/p\u003e\n\u003cp\u003eC.S. contributed to study supervision, methodological guidance, conflict resolution during screening, critical revision of the manuscript, and approval of the final version.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOana Diana Damian is an Orthopedic Registrar in Ireland with previous clinical experience in outpatient musculoskeletal care in a regional hospital in Romania. Her academic interests include minimally invasive orthopedic procedures and the optimization of surgical care in ambulatory settings.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLewis C, Mauffrey C, Newman S, Lambert A, Hull P. Current concepts in carpal tunnel syndrome: a review of the literature. Eur J Orthop Surg Traumatol. 2010;20(6):445\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00590-010-0585-9\u003c/span\u003e\u003cspan address=\"10.1007/s00590-010-0585-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzar FM, Canale ST, Beatty JH, editors. Campbell\u0026rsquo;s operative orthopaedics. 14th ed. Philadelphia: Elsevier; 2021. pp. 3857\u0026ndash;e38844.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHidayati HB, Subadi I, Fidiana F, Puspamaniar VA. Current diagnosis and management of carpal tunnel syndrome: a review. Anaesth Pain Intensive Care. 2022;26(3):394\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.35975/apic.v26i3.1902\u003c/span\u003e\u003cspan address=\"10.35975/apic.v26i3.1902\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eN\u0026uacute;\u0026ntilde;ez-Cort\u0026eacute;s R, Espin A, P\u0026eacute;rez-Alenda S, L\u0026oacute;pez-Bueno R, Cruz-Montecinos C, Vincents-Seeberg KG et al. (2023) Association between pain coping and symptoms of anxiety and depression and work absenteeism in people with upper limb musculoskeletal disorders: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2023;105(4):781-9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.apmr.2023.07.003\u003c/span\u003e\u003cspan address=\"10.1016/j.apmr.2023.07.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State. Am J Ind Med. 2007;50:155\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ajim.20430\u003c/span\u003e\u003cspan address=\"10.1002/ajim.20430\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHidayati HB, Subadi I, Fidiana F, Puspamaniar VA. Current diagnosis and management of carpal tunnel syndrome: a review. Anaesth Pain Intensive Care. 2022;26(3):394\u0026ndash;404. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.35975/apic.v26i3.1902\u003c/span\u003e\u003cspan address=\"10.35975/apic.v26i3.1902\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede la Fuente J, Aramendi JF, Ibanez JM, Blasi M, Vazquez A, Aurrekoetxea JJ. Minimally invasive ultrasound-guided vs open release for carpal tunnel syndrome in working population: a randomized controlled trial. J Clin Ultrasound. 2021;49(7):693\u0026ndash;703. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jcu.23019\u003c/span\u003e\u003cspan address=\"10.1002/jcu.23019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEberlin KR, Amis BP, Berkbigler TP, Dy CJ, Fischer MD, Gluck JL. Multicenter randomized trial of carpal tunnel release with ultrasound guidance versus mini-open technique. Expert Rev Med Devices. 2023;20(7):597\u0026ndash;605. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/17434440.2023.2218548\u003c/span\u003e\u003cspan address=\"10.1080/17434440.2023.2218548\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEberlin KR, Dy CJ, Fischer MD, Gluck JL, Kaplan FTD, McDonald TJ. Trial of ultrasound guided carpal tunnel release versus traditional open release (TUTOR). Medicine. 2022;101(41):e30775. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MD.0000000000030775\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000030775\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRandall DJ, et al. Moving minor hand surgeries out of the operating room and into the office-based procedure room: a population-based trend analysis. J Hand Surg Am. 2022;47(12):1137\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhsa.2022.08.026\u003c/span\u003e\u003cspan address=\"10.1016/j.jhsa.2022.08.026\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsserson DB, North TJ, Rhee PC, Bishop AT, Brault JS, Shin AY. Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study. J Hand Surg Eur Vol. 2022;47(4):359\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/17531934211051276\u003c/span\u003e\u003cspan address=\"10.1177/17531934211051276\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergum RA, Ciota MR. Office-based carpal tunnel release using ultrasound guidance in a community setting: long-term results. Cureus. 2022;14(7):e27169. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.27169\u003c/span\u003e\u003cspan address=\"10.7759/cureus.27169\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCroutzet P, Guinand R, Djerbi I. Birth and growth of an ultrasound hand surgery center: a review of 1167 procedures. Ortho J Sports Med. 2019;7(5suppl3):2325967119S0021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/2325967119S00216\u003c/span\u003e\u003cspan address=\"10.1177/2325967119S00216\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCumpston M, Chandler J et al. Chapter II: planning a Cochrane review. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, editors. Cochrane handbook for systematic reviews of interventions (version 6.4). Cochrane; 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.training.cochrane.org/handbook\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCochrane Community. PICO search about. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://community.cochrane.org/pico-search-about\u003c/span\u003e\u003cspan address=\"https://community.cochrane.org/pico-search-about\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 30 Oct 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePRISMA. PRISMA 2020 flow diagram. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.prisma-statement.org/prisma-2020-flow-diagram\u003c/span\u003e\u003cspan address=\"https://www.prisma-statement.org/prisma-2020-flow-diagram\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed 13 Jul 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg. 1993;75(11):1585\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/00004623-199311000-00002\u003c/span\u003e\u003cspan address=\"10.2106/00004623-199311000-00002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCovidence. Covidence systematic review software. Veritas Health Innov. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.covidence.org/\u003c/span\u003e\u003cspan address=\"https://www.covidence.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHayward C. Sizing imaging and procedure rooms. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://blog.spacemed.com/sizing-imaging-and-procedure-rooms/\u003c/span\u003e\u003cspan address=\"https://blog.spacemed.com/sizing-imaging-and-procedure-rooms/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 17 Dec 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJerosch-Herold C, Bland JDP, Horton M. Is it time to revisit the Boston Carpal Tunnel Questionnaire? New insights from a Rasch model analysis. Muscle Nerve. 2021;63(4):484\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/mus.27173\u003c/span\u003e\u003cspan address=\"10.1002/mus.27173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehta SP, Weinstock-Zlotnick G, Akland KL, Hanna MM, Workman KJ. Using Carpal Tunnel Questionnaire in clinical practice: a systematic review of its measurement properties. J Hand Ther. 2020;33(4):493\u0026ndash;506. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jht.2019.12.011\u003c/span\u003e\u003cspan address=\"10.1016/j.jht.2019.12.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoanna Briggs Institute. JBI critical appraisal checklist for randomized controlled trials. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jbi.global/sites/default/files/2020-08/Checklist_for_RCTs.pdf\u003c/span\u003e\u003cspan address=\"https://jbi.global/sites/default/files/2020-08/Checklist_for_RCTs.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoanna Briggs Institute. JBI critical appraisal checklist for cohort studies. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jbi.global/sites/default/files/2019-05/JBI_Cohort_Appraisal_tool2017_0.pdf\u003c/span\u003e\u003cspan address=\"https://jbi.global/sites/default/files/2019-05/JBI_Cohort_Appraisal_tool2017_0.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoanna Briggs Institute. JBI critical appraisal checklist for case series. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jbi.global/sites/default/files/2019-05/JBI_Case_Series_Appraisal_tool2017_0.pdf\u003c/span\u003e\u003cspan address=\"https://jbi.global/sites/default/files/2019-05/JBI_Case_Series_Appraisal_tool2017_0.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoanna Briggs Institute. JBI critical appraisal tools. 2020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jbi.global/critical-appraisal-tools\u003c/span\u003e\u003cspan address=\"https://jbi.global/critical-appraisal-tools\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMicrosoft Corporation. Microsoft Excel. Microsoft 365. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.microsoft.com/en-us/microsoft-365/excel\u003c/span\u003e\u003cspan address=\"https://www.microsoft.com/en-us/microsoft-365/excel\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOpenAI. ChatGPT: data analysis, visualization, and ideation [Large language model]. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://chat.openai.com/\u003c/span\u003e\u003cspan address=\"https://chat.openai.com/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 17 Dec 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen J. A coefficient of agreement for nominal scales. Educat Psychol Measure. 1960;20(1):37\u0026ndash;46. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/001316446002000104\u003c/span\u003e\u003cspan address=\"10.1177/001316446002000104\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim IJ, Kim JM. Long-term outcomes of ultrasound-guided thread carpal tunnel release and its clinical effectiveness in severe carpal tunnel syndrome: a retrospective cohort study. J Clin Med. 2024;13(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm13010262\u003c/span\u003e\u003cspan address=\"10.3390/jcm13010262\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo D, Guo J, Schmidt SC, Lytie RM. A clinical study of the modified thread carpal tunnel release. Hand. 2017;12(5):453\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1558944716668831\u003c/span\u003e\u003cspan address=\"10.1177/1558944716668831\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChern TC, Kuo LC, Shao CJ, Wu TT, Wu KC, Jou IM. Ultrasonographically guided percutaneous carpal tunnel release: early clinical experiences and outcomes. Arthroscopy. 2015;31(12):2400\u0026ndash;10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arthro.2015.06.023\u003c/span\u003e\u003cspan address=\"10.1016/j.arthro.2015.06.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetrover D, Silvera J, De Baere T, Vigan M, Hakim\u0026eacute; A. Percutaneous ultrasound-guided carpal tunnel release: study upon clinical efficacy and safety. Cardiovasc Intervent Radiol. 2017;40(4):568\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00270-016-1545-5\u003c/span\u003e\u003cspan address=\"10.1007/s00270-016-1545-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMende K, Kamphuis SJM, Schmid V, Schaefer DJ, Kaempfen A, Gohritz A. Early postoperative recovery after modified ultra-minimally invasive sonography-guided thread carpal tunnel release. J Pers Med. 2023;13(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jpm13040610\u003c/span\u003e\u003cspan address=\"10.3390/jpm13040610\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamel SI, Freid B, Pomeranz C, Halpern EJ, Nazarian LN. Minimally invasive ultrasound-guided carpal tunnel release improves long-term clinical outcomes in carpal tunnel syndrome. Am J Roentgenol. 2021;217(2):460\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2214/AJR.20.24383\u003c/span\u003e\u003cspan address=\"10.2214/AJR.20.24383\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChappell CD, Beckman JP, Baird BC, Takke AV. Ultrasound (US) changes in the median nerve cross-sectional area after microinvasive US-guided carpal tunnel release. J Ultrasound Med. 2020;39(4):693\u0026ndash;702. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jum.15146\u003c/span\u003e\u003cspan address=\"10.1002/jum.15146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBland JDP. A neurophysiological grading scale for carpal tunnel syndrome. Muscle Nerve. 2000;23(9):1280\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/1097-4598(200009)23\u003c/span\u003e\u003cspan address=\"10.1002/1097-4598(200009)23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoscato L, Helmi A, Kouyoumdjian P, Lalonde D, Mares O. The impact of WALANT anesthesia and office-based settings on patient satisfaction after carpal tunnel release: a patient reported outcome study. Orthop Traumatol Surg Res. 2023;109(3):103134. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.otsr.2021.103134\u003c/span\u003e\u003cspan address=\"10.1016/j.otsr.2021.103134\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCano LC, et al. Clinical results of carpal tunnel release using ultrasound guidance in over 100 patients at two to six years. J Hand Surg Glob Online. 2024;6(3):354\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhsg.2024.03.004\u003c/span\u003e\u003cspan address=\"10.1016/j.jhsg.2024.03.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAguila D, et al. Long-term clinical results of carpal tunnel release using ultrasound guidance: a multicenter pragmatic study. J Hand Surg Glob Online. 2024;6(1):79\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhsg.2023.11.002\u003c/span\u003e\u003cspan address=\"10.1016/j.jhsg.2023.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWise A, Pourcho AM, Henning PT, Latzka EW. Evidence for ultrasound-guided carpal tunnel release. Curr Phys Med Rehabil Rep. 2021;9(1):11\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40141-020-00305-0\u003c/span\u003e\u003cspan address=\"10.1007/s40141-020-00305-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall MM, Kliethermes SA, Henning PT, Hoffman DF, Mautner K, Obunadike E, et al. Three-month complication rate of ultrasound-guided soft tissue surgical procedures across six sports medicine clinics. J Ultrasound Med. 2023;42(11):2629\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.doi.org/10.1002/jum.16298\u003c/span\u003e\u003cspan address=\"10.1002/jum.16298\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenson LS, Bare AA, Nagle DJ, Harder VS, Williams CS, Visotsky JL. Complications of endoscopic and open carpal tunnel release. Arthroscopy. 2006;22(9):919\u0026ndash;e242. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arthro.2006.05.008\u003c/span\u003e\u003cspan address=\"10.1016/j.arthro.2006.05.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApard T, Candelier G. Surgical ultrasound-guided carpal tunnel release. Hand Surg Rehabil. 2017;36(5):333\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.doi.org/10.1016/j.hansur.2017.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.hansur.2017.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam KHS, Wu Y-T, Reeves KD, Galluccio F, Allam AE-S, Peng PWH. Ultrasound-guided interventions for carpal tunnel syndrome: a systematic review and meta-analyses. Diagnostics. 2023;13(6):1138. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/diagnostics13061138\u003c/span\u003e\u003cspan address=\"10.3390/diagnostics13061138\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurnham RS, Loh EY, Rambaransingh B, Roberts SL, Agur AM, Playfair LD. A controlled trial evaluating the safety and effectiveness of ultrasound-guided looped thread carpal tunnel release. Hand (N Y). 2021;16(1):73\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1558944719842199\u003c/span\u003e\u003cspan address=\"10.1177/1558944719842199\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVasiliadis HS, Nikolakopoulou A, Shrier I, Lunn MP, Brassington R, Scholten RJP, et al. Endoscopic and open release similarly safe for the treatment of carpal tunnel syndrome. a systematic review and meta-analysis. PLoS ONE. 2015;10(12):e0143683. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0143683\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0143683\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOhuchi H, Hattori S, Shinga K, Ichikawa K, Yamada S. Ultrasound-assisted endoscopic carpal tunnel release. ArthroscTech. 2016;5(3):e483\u0026ndash;87. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.eats.2016.01.035\u003c/span\u003e\u003cspan address=\"10.1016/j.eats.2016.01.035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Demark RE, Becker HA, Anderson MC, Smith VJS. Wide-awake anesthesia in the in-office procedure room: lessons learned. Hand (N Y). 2018;13(4):481\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1558944717715120\u003c/span\u003e\u003cspan address=\"10.1177/1558944717715120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeBlanc MR, Lalonde DH, Thoma A, Bell M, Wells N, Allen M, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (N Y). 2011;6(1):60\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11552-010-9301-9\u003c/span\u003e\u003cspan address=\"10.1007/s11552-010-9301-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilver N, Lalonde DH. Main operating room versus field sterility in hand surgery: a review of the evidence. Plast Surg (Oakv). 2023;32(4):627\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/22925503231161073\u003c/span\u003e\u003cspan address=\"10.1177/22925503231161073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRhee PCDOMS, Fischer MM, Rhee LSDOMHA, McMillan H, Johnson AEMD. Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg (Am). 2017;42(3):e139\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jhsa.2016.11.019\u003c/span\u003e\u003cspan address=\"10.1016/j.jhsa.2016.11.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIngram J, Mauck BM, Thompson NB, Calandruccio JH. Cost, value, and patient satisfaction in carpal tunnel surgery. Orthop Clin North Am. 2018;49(4):503\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ocl.2018.06.005\u003c/span\u003e\u003cspan address=\"10.1016/j.ocl.2018.06.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"carpal tunnel syndrome, ultrasound-guided release, ambulatory surgery, patient satisfaction, functional outcome, BCTQ","lastPublishedDoi":"10.21203/rs.3.rs-8968369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8968369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCarpal tunnel syndrome (CTS) is a prevalent neuropathy that affects individuals' quality of life and causes significant socioeconomic costs. Traditional treatments include surgical decompression, but a novel minimally invasive technique, ultrasound-guided carpal tunnel release (USG-CTR), offers similar outcomes with potentially lower costs and greater convenience. This systematic review evaluates the effectiveness of USG-CTR conducted in procedures (PR) and interventional radiology rooms (IR) compared with operating rooms (OR) in terms of patient satisfaction, hand function, and symptomatology.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA detailed search was conducted using the EMBASE, MEDLINE, CENTRAL, and Scopus databases up to May 2024. The inclusion criteria were studies assessing USG-CTR outcomes in different settings using standardized measures such as the Boston Carpal Tunnel Questionnaire (BCTQ) and the visual analog scale. Improvements were expressed as mean changes in the BCTQ functional and symptom severity scores. Bias assessment was performed using the Joanna Briggs Institute critical appraisal checklists.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom the 296 screened studies, 9 met the inclusion criteria: 1 RCT, 1 retrospective cohort study, and 7 case series. High levels of patient satisfaction were reported across the PR and IR settings, with significant improvements in BCTQ functional status scale and symptom severity scale scores. No substantial differences were observed between the PR, IR, and OR settings in terms of symptom relief and functional outcomes.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCurrent evidence suggests that the USG-CTR in PR and IR settings is as effective as it is in OR settings, offering high patient satisfaction and improved hand function and symptomatology. These findings support the adoption of the USG-CTR in nontraditional settings to potentially reduce costs and increase accessibility. Future research should standardize outcome measures and explore long-term effects across various settings.\u003c/p\u003e","manuscriptTitle":"Ultrasound-guided carpal tunnel release outside the operating theatre. Patient satisfaction, hand function, and symptomatology. A systematic review. ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 16:15:31","doi":"10.21203/rs.3.rs-8968369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-31T14:22:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-02T13:47:10+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-02T13:45:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2026-02-25T13:33:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1b0c6c3-32de-4580-ae6c-02988d7b9b70","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T16:15:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 16:15:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8968369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8968369","identity":"rs-8968369","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}