A comparative analysis of the efficacy and safety of arthroscopic and ultrasound-guided carpal tunnel release in the treatment of carpal tunnel syndrome

To retrospectively compare the clinical efficacy and safety of ACTR and UG-CTR in the treatment of CTS with the help of homemade shim to protect the median nerve. A total of 99 patients were included from January 2022 to March 2025, among whom 54 received ACTR treatment and 45 received UG-CTR treatment. The results showed that UG-CTR was superior to ACTR in terms of surgical time (21.09 ± 7.32 min vs. 33.35 ± 10.09 min, P < 0.001) and surgical cost (4161.25 ± 316.32 yuan vs. 8271.10 ± 585.80 yuan, P < 0.001). Both groups showed significant improvements in VAS scores, Boston Carpal Tunnel Questionnaire scores (SSS and FSS), and neurophysiological parameters (sensory nerve conduction velocity and sensory nerve action potential) at 1, 3, and 6 months after surgery. Repeated-measures analysis showed a significant main effect of time for all measures (all P < 0.001), whereas no significant main effect of group and no significant group × time interaction were observed for any measure (all P > 0.05). No significant difference was observed between the two groups at any time point. At 6 months after surgery, the total effective rate of the ACTR group was 92.59%, and that of the UG-CTR group was 97.78% ( P = 0.241). There were no significant differences in the complication rate and short-term recurrence rate between the two groups ( P > 0.05). In conclusion, both ACTR and UG-CTR (with spacer protection devices) are safe and effective minimally invasive surgical methods for treating carpal tunnel syndrome. No significant difference was observed between the two groups with respect to pain relief, functional recovery, or neurofunctional improvement within 6 months after surgery. However, UG-CTR has more advantages in shortening the surgical time and reducing medical costs, and shows a good clinical application prospect. Clinical trial registration number. Not applicable