Clinical efficacy of ultrasound-guided needle knife therapy for carpal tunnel syndrome: A meta-analysis of randomized controlled trials

Abstract

Background:

Ultrasound-guided needle-knife therapy has emerged as a widely adopted and clinically effective intervention for carpal tunnel syndrome (CTS), demonstrating significant therapeutic outcomes in clinical practice. However, there is currently a notable lack of systematic reviews and meta-analyses evaluating the therapeutic efficacy of ultrasound-guided needle-knife therapy in the management of CTS. Systematic review and meta-analysis to assess the effectiveness of ultrasound-guided needle-knife therapy in improving CTS symptoms, wrist function, nerve conduction, ultrasonic detection index, and clinical cure rate.

Methods:

A PICO (Population [study participants], Intervention [exposure or treatment], Comparison [control intervention], and Outcome [key study outcomes]) search strategy was used to identify randomized controlled trials applying ultrasound-guided needle-knife therapy on patients with CTS. Methodology quality and risk of bias were assessed by the Cochrane Collaboration. Outcomes assessed were pain intensity, wrist function, nerve conduction, ultrasonic detection index, clinical effective rate, and clinical cure rate.

Results:

Seventeen studies involving 996 patients were finally included. Test for overall effect using a random effects model showed that ultrasound-guided needle-knife therapy significant improving pain intensity (Visual Analogue Scale) (mean difference [MD] = 0.84, 95% confidence interval [CI] −1.13 to −0.55, P < .00001, I² = 85%), wrist function (standardized mean difference = 1.22, 95% CI: 1.59 to −0.84, P < .00001; I² = 80%), nerve sensory conduction (sensory conduction velocity) (MD = 3.32, 95% CI: 2.38–4.25, P < .00001; I² = 54%), nerve motor conduction (distal motor latency) (MD = −0.46, 95% CI: −0.64 to −0.28, P < .00001; I² = 80%), ultrasonic detection indicators (cross-section area) (MD = −1.88, 95% CI: −3.14 to −0.62, P =.03; I² = 96%), and thickness of the transverse carpal ligament (MD = −0.68, 95% CI: −1.20 to −0.15, P < .00001; I² = 94%), clinical effective rate (MD = 1.14, 95% CI: 1.09–1.20, P < .00001; I² = 46%), and clinical cure rate (MD = 1.69, 95% CI: 1.42–2.00, P < .00001; I² = 46%) compared with those of the CTS patients in the control group.

Conclusions:

This study highlights that ultrasound-guided needle-knife technology has significant effectiveness on pain, wrist function, nerve conduction, ultrasonic detection indicators (cross-section area, thickness of the transverse carpal ligament), clinical effective rate, and clinical cure rate for patients with CTS.

1. Introduction

Carpal tunnel syndrome (CTS), also referred to as median nerve compression syndrome, is the most common peripheral nerve entrapment syndrome worldwide.^[1] CTS is caused by compression of the median nerve at the wrist as it passes through a space-limited osteofibrous canal, resulting in numbness and abnormal sensory changes in the thumb, index, middle, and radial half of the ring finger, varying degrees of atrophy of the thenar muscle and varying degrees of limitation of the function of the thumb against the palm.^[2,3] Oedema, tendon inflammation, hormonal changes, and manual activity can contribute to increased nerve compression and sometimes cause pain, as in the case of tendon inflammation. In more severe cases, weakness of median nerve innervated muscles can occur, resulting in hand weakness. CTS is more common in those who frequently use the hand and wrist. The estimated prevalence of CTS in adults is 7%~16% in the United kingdom.^[4] In the United States, the annual number of patients undergoing surgical treatment is estimated to be within the range of 400,000 to 500,000, accompanied by an associated economic burden exceeding $2 billion per year.^[5,6] If CTS is not prevented and treated in time, it can lead to hand disability,^[7] loss of working ability, and affect work and life.

Currently, the treatment of CTS includes nonsurgical and surgical options. For patients exhibiting intermittent symptoms without evidence of permanent nerve damage, nonsurgical treatment modalities such as nocturnal wrist splinting or local corticosteroid injections into the carpal tunnel should be prioritized.^[8] Corticosteroid blocking therapy is short term therapy but usually relapses within 2 to 4 months. If the first steroid treatment does not work, steroid treatment should not be repeated.^[9] Surgical intervention should be considered if nonsurgical treatments prove ineffective or if more severe symptoms, such as decreased sensitivity or muscle atrophy, are present.

Needle knife is a commonly used surgical treatment for CTS, but it is a blind operation under non-direct vision, relying on the operator’s clinical experience and underhand sensation, which is prone to damage non-lesioned tissues and increase the risk of neurological and vascular injuries.^[10] In contrast, ultrasound-guided treatment provides clear visualization of the sonographic images of the median nerve, transverse carpal ligament, and surrounding tissue structures.^[11] Moreover, the needle-knife operation under ultrasound guidance can be directly observed, thereby enhancing the precision and safety of the procedure. At present, there have been systematic reviews on ultrasound-guided steroid injection in the treatment of carpal tunnel syndrome (CTS),^[12] and it has been proved that it has a good clinical effect. However, a systematic review of research methods to confirm the clinical efficacy of ultrasound-guided needle-knife therapy for CTS is still lacking. Therefore, the purpose of this study was to conduct a systematic review and meta-analysis in order to compare the effects of ultrasound-guided needle-knife therapy on pain intensity, wrist function, and nerve conduction outcomes in patients with CTS.

2. Materials and methods

The protocol for this review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement^[13] and was registered in the International Prospective Register of Systematic Reviews (Identifier: CRD42025643362).

2.1. Study search and selection

References were searched for on PubMed, Embase, Medline, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Wan Fang, and Chinese Vipp databases up to Jan 2025 without any date and language restrictions. The keywords used for the search are collated by us in Table 1. “Ultrasound-Guided and Carpal Tunnel Syndrome (or Syndrome, Carpal Tunnel or Compression Neuropathy, Carpal Tunnel or Median Neuropathy, Carpal Tunnel), Needle knife therapy (or Acupotomy) and Carpal Tunnel Syndrome (or Syndrome, Carpal Tunnel or Compression Neuropathy, Carpal Tunnel or Median Neuropathy, Carpal Tunnel)” were used as a search strategy to search across various databases. The search strategies and results are described in Appendix 1 (Supplementary documents, Supplemental Digital Content, https://links.lww.com/MD/Q819).

Table 1.

Keywords used for the search strategy.

Population	Intervention
Carpal tunnel syndrome Carpal tunnel syndrome Carpal tunnel compression neuropathy Carpal tunnel median neuropathy	Ultrasound-guided needle-knife therapy Acupotomy Ultrasound-guided needle-knife therapy Ultrasound-guided acupotomy

2.2. Inclusion criteria

The inclusion criteria of this meta-analysis included: the study was conducted on patients diagnosed with CTS; reporting quantitative data related to wrist function or visual analogue scales or median wrist nerve EMG parameters or median nerve cross section area (CSA); the intervention method of the experimental group was ultrasound-guided needle-knife therapy, and the control group received either non-ultrasonic guided needle-knife technique or traditional acupotomy technique or no intervention using randomized control trial design.

2.3. Exclusion criteria

Studies excluded patients with non-CTS or CTS plus disorders; the intervention was ultrasound-guided steroid injection, the trial was not conducted with a comparison group, or data on baseline score or end-point outcome were not provided sufficiently. Review articles, editorials, and conferences were also excluded.

Duplicates article from the search was used to eliminate by EndNote X9, and then, the titles and abstracts of articles to establish their appropriateness for inclusion were independently assessed by 2 reviewers (PG and JZ). Articles that did not meet the inclusion criteria were not considered further. Those that could not be eliminated were retrieved, and the full text was reviewed by 2 persons (QZ and XL). The authors were contacted via email when data confirmation or further information was requested. Any disagreement was resolved by discussion, and a third reviewer (FT) was consulted if a disagreement persisted.

2.4. Data extraction and quality assessment

The following data were extracted: first author, year of publication, simple size, age, sex, description of treatment, duration of trial period, outcome measurements, and adverse effect of the study participants. The quality of the included studies was evaluated using the Cochrane Collaboration’s risk of bias guidelines.^[14] We will assess the risk of bias (low, high, and unclear risk) in 7 areas, including: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessments, incomplete outcome data, selective reporting, and other biases. The final decisions will be determined by a third reviewer (FT) if discrepancies appear.

2.5. Types of outcome measures

The primary outcome parameters included pain intensity (visual analogue scales [VAS]), wrist function (Boston carpal tunnel questionnaire score [BCTQ], Levine carpal tunnel syndrome questionnaire [LCTSQ]), nerve conduction (distal motor latency [DML], sensory conduction velocity [SCV]), and ultrasonic detection index (CSA, thickness of transverse carpal ligament [TTCL]). Furthermore, the secondary outcome parameters comprised clinical effective rate and clinical cure rate.

2.6. Data synthesis and statistical analysis

All outcome parameters included in the meta-analysis for this study included continuous and dichotomous variables. Mean difference (MD) with 95% confidence interval (CI) was used for continuous variables, and standardized mean difference and 95% CI were used for continuous variables if the units were different. The meta-analysis was performed using RevMan 5.3 and Stata 14.0 software for data processing. The Q statistic was used to test for heterogeneity, and if P > .05 and I² ≤ 50% indicated that the studies were homogeneous, they were analyzed using a fixed-effects model. Otherwise, a random‐effect model was used for analysis. A sensitivity analysis was conducted to demonstrate the reliability of our meta-analysis results by removing each study to evaluate the consistency and quality of the results.^[15] Publication bias was evaluated using an Egger asymmetry test, and the trim and fill method were performed to detect the effect of publication bias on the results.^[16] Statistically significant differences were set at α = 0.05.

3. Results

3.1. Search results

A total of 458 records were searched, and 255 records were included in the initial screening by removing duplicates articles and ineligible articles. The abstract and text for each study based on our inclusion and exclusion criteria were reviewed by 2 reviewers. We excluded 167 studies because of review articles, case report, review, unrelated study design, and unrelated interventions, and 55 records were included in the full-text screening. Through screening, we excluded another 38 studies that did not fit the criteria such as unavailability of full text, unrelated study design, interventions, unrelated treatment, and unrelated outcome parameters (e.g., protocol studies). In the end, 17 studies met the inclusion criteria, and they all were published in Chinese. The flow diagram of the selection process is shown in Figure 1.

Figure 1.

The flow diagram of the selection process.

3.2. Participant characteristics

Table 2 summarizes the characteristics of each included study. The 17 articles covered 996 patients with CTS (range of mean age = 38.5~57.64 years), and the mean age of CTS’s patients in 1 study^[33] was not reported. The countries or regions of publication are from the People’s Republic of China. Six of the 17 total studies^[17,23–27] reported adverse effect.

Table 2.

Basic characteristics of the included studies.

Study	Simple size (E/C, n)	Age (E/C, yr)	Sex (M/F)	Treatment method	Course of treatment	Outcome	Adverse effect
Dai et al [17] (China)	20/20	47.95 ± 12.75/44.05 ± 12.75	17/23	E: Ultrasonic visualization technology of needle-knife C: Traditional needle-knife	Once a week, 4 times for 1 course of treatment	VAS, LCTSQ, TTCL	C: 1 case reported
Fan et al[18] (China)	20/20	50 ± 8/47 ± 12	14/26	E: Ultrasound-guided needle-knife combined with compound betamethasone injection C: Compound betamethasone injection	A total of 2 treatments, each 5 days apart	VAS, CER, CCR	NR
Feng et al[19] (China)	30/30	45.80 ± 7.66/47.12 ± 7.93	18/42	E: Treatment with lidocaine + triamcinolone acetonide + vitamin B12 mixture injection combined with ultrasound fine needle aspiration modified mini-needle-knife C: Treatment with lidocaine + tretinoin + vitamin B12 mix injection combined with traditional mini-needle-knife	1 time a week for 3 wk	VAS, BCTQ, SCV, DML, CSA, CER, CCR	NR
Guan et al[20] (China)	32/31	41.29 ± 9.82/41.57 ± 10.24	26/37	E: High-frequency ultrasound guided small needle-knife treatment C: Only needle-knife treatment	NR	VAS, CSA, CER, CCR	NR
Guo et al[21] (China)	48/38	39.51 ± 6.72/38.56 ± 6.64	25/61	E: Ultrasound-guided local injection of compound betamethasone combined with needle-knife C: Compound betamethasone local injection combined with traditional needle-knife therapy	Both groups were treated once	BCTQ, SCV, DML, CER, CCR	NR
Jiao[22] (China)	30/30	45.08 ± 0.91/46.41 ± 0.50	29/31	E: Ultrasound-guided needle-knife release of transverse ligament of wrist combined with nerve block treatment C: Conventional therapy	Both groups were treated once	SCV, DML, CSA	NR
Li et al[23] (China)	31/31	47.84 ± 9.96/46.71 ± 10.13	21/41	E: Ultrasound-guided dental crochet knife C: Traditional tooth crochet knife treatment	Both groups were treated once	CSA, TTCL, CER, CCR	E: 2 cases reported C: 8 cases reported
Tang[24] (China)	20/20	40.16 ± 5.46/40.68 ± 5.68	23/17	E: Ultrasound-guided needle-knife C: Traditional needle-knife	Once weekly for 4 wk	VAS, LCTSQ, TTCL CER, CCR	E: 1 case reported C: 6 cases reported
Nong et al[25] (China)	34/34	57.26 ± 2.33/57.64 ± 2.40	35/33	E: Ultrasound-guided needle-knife C: Traditional needle-knife	Both groups were treated once	VAS, LCTSQ, TTCL,CER, CCR	C: 4 cases reported
Qian[26] (China)	20/20	47.85 ± 12.50 /44.05 ± 13.70	13/27	E: Ultrasound-guided needle-knife C: Traditional needle-knife	Once weekly for 3 wk	LCTSQ, SCV, DML, CER, CCR	C: 1 case reported
Shen et al[27] (China)	26/26	45.03 ± 8.24/43.82 ± 7.45	19/33	E: Wide-awake combined with musculoskeletal ultrasonography assisted needle-knife operation C: Traditional needle-knife operation	Both groups were treated once	VAS, LCTSQ, SCV, DML, CER, CCR	C: 1 case reported
Song et al[28] (China)	30/30	42.85 ± 1.47/43.67 ± 1.18	28/32	E: ultrasound-guided needle-knife combined exercise training C: Closure therapy combined with exercise training	Once weekly for 3 wk	CSA, BCTQ, SCV, DML, TTCL, CER, CCR	NR
Wang et al[29] (China)	21/20	45.37 ± 6.79/45.78 ± 6.26	7/34	E: Ultrasound-guided needle-knife combined with nerve block treatment C: Traditional needle-knife combined with nerve block treatment	Once weekly for 2 wk	VAS, BCTQ SCV, DML, CSA,CER, CCR	NR
Wei[30] China)	30/30	48.65 ± 6.79/49.02 ± 7.32	22/38	E: Ultrasound-guided needle-knife C: Traditional needle-knife	NR	BCTQ, SCV, DML, CSA TTCL, CER, CCR	NR
Xu et al[31] (China)	32/32	51.65 ± 9.29/51.24 ± 13.42	16/48	E: Hydrodissection of steroid-containing fluids combined with ultrasound-guided needle-knife C: Hydrodissection of steroid-containing fluids	Biweekly, 2 treatments in total	VAS, BCTQ, CSA	NR
Yu et al[32] (China)	40/40	38.5 ± 15.91/42.0 ± 15.36	35/45	E: Ultrasound-guided needle-knife C: Traditional needle-knife	Once weekly for 4 wk	VAS, BCTQ, CER, CCR	NR
Zhang et al[33] (China)	25/25	NR	NR	E: Ultrasound-guided drug combined with needle-knife C: Ultrasound-guided drug therapy alone	Once weekly for 3 wk	VAS, CSA, CER, CCR	NR

BCTQ = Boston Carpal Tunnel Questionnaire score, CCR = clinical cure rate, CER = clinical effective rate, CSA = cross-section area of median nerve, DML = distal motor latency, LCTSQ = Levine Carpal Tunnel Syndrome Questionnaire score, NR = not reported, SCV = sensory conduction velocity, TTCL = thickness of the transverse carpal ligament, VAS = Visual Analogue Scale.

3.3. Risk of bias among the selected articles

The risk of bias of all selected articles were assessed using the Cochrane Collaboration’s techniques. In the domain of random sequence generation, 4 article reported high risk of bias.^{[21,23,30,31]} Allocation concealment was at high risk of bias in 10 articles,^{[17–21,23,25,26,30,32]} while other 4 articles described unclear risk of bias.^{[27,29,31,33]} None of the studies blinded their participants or personnel. Low risk of bias was reported in blinding of outcome assessment, incomplete outcome data, and selective reporting. Unclear risk of other bias was reported in all articles. These results are summarized in Figure 2.

Figure 2.

Risk of bias summary.

3.4. Effects of ultrasound-guided needle-knife therapy on primary outcomes

3.4.1. Pain intensity

The pain intensity was assessed by means of VAS. In this study, 12 articles^{[17–20,22,24,25,27,29,31–33]} involving 658 patients compared VAS between CTS patients performing ultrasound-guided needle-knife therapy and those in the control group. Based on a random effects model, ultrasound-guided needle-knife therapy was found to decrease pain intensity (VAS) (MD = 0.84, 95% CI −1.13 to −0.55, P < .00001, I² = 85%) compared with those in the control group (Fig. 3).

Figure 3.

Meta-analyses of the effect of ultrasound-guided needle-knife therapy on VAS compared with the control group. VAS = visual analogue scale.

3.4.2. Wrist function

Wrist function outcome was assessed by means of the Boston carpal tunnel syndrome questionnaire and LCTSQ score in the studies included for this meta-analysis. Twelve articles involving 699 patients compared the wrist function between CTS patients performing ultrasound-guided needle-knife therapy and those in the control group. Of these, 8 articles^{[19,21,22,28–32]} used BCTQ to assess wrist function and the other 4 articles^[17,24–26] used LCTSQ to assess wrist function. Based on a random effects model, the BCTQ and LCTSQ of patients performing ultrasound-guided needle-knife therapy significantly decreased (standardized mean difference = 1.22, 95% CI 1.59 to −0.84, P < .00001; I² = 80%) compared with those of the patients in the control group (Fig. 4). The result found that wrist function of CTS patients was significant improved by ultrasound-guided needle-knife therapy.

Figure 4.

Meta-analyses of the effect of ultrasound-guided needle-knife therapy on wrist function compared with the control group.

3.4.3. Nerve conduction

The nerve conduction of media is composed of nerve sensory conduction and nerve motor conduction. Among these, the nerve motor conduction is assessed through the measurement of DML, while the nerve sensory conduction is evaluated by determining the SCV. Thereby the nerve conduction studies are the gold standard for CTS diagnosis to assess the SCV and DML. A total of 8 articles,^{[19,21,22,26–30]} respectively, compared the DML and SCV between CTS patients using ultrasound-guided needle-knife therapy and those in the control group. Test for overall effect using a random effects model showed that ultrasound-guided needle-knife therapy significant increased nerve sensory conduction (SCV) (MD = 3.32, 95% CI 2.38 to 4.25, P < .00001; I² = 54%) decreased nerve motor conduction (DML) (MD = −0.46, 95% CI −0.64 to −0.28, P < .00001; I² = 80%) compared with those of the patients in the control group (Fig. 5). The result indicating that ultrasound-guided needle-knife therapy significant improved nerve motor conduction and nerve sensory conduction.

Figure 5.

Meta-analyses of the effect of ultrasound-guided needle-knife therapy on nerve conduction (SCV, DML) compared with the control group. DML = distal motor latency, SCV = sensory conduction velocity.

3.4.4. Ultrasonic detection index

Ultrasonic detection index comprises CSA and TTCL of pea bone. In this study, a total of 8 articles^{[20,22,23,28–31,33]} and 6 articles,^{[17,23–25,28,30]} respectively, compared ultrasonic detection indicators (CSA, TTCL) in CTS patients treated with ultrasound-guided needle-knife therapy with those in the control group. Test for overall effect using a random effects model showed that ultrasound-guided needle-knife therapy significant decreased CSA (MD = −1.88, 95% CI −3.14 to −0.62, P = .03; I² = 96%) and TTCL (MD = −0.68, 95% CI −1.20 to −0.15, P < .00001; I² = 94%) compared with those of the patients in the control group (Fig. 6).

Figure 6.

Meta-analyses of the effect of ultrasound-guided needle-knife therapy on ultrasonic detection index (CSA, TTCL) compared with the control group. CSA = cross section area, TTCL = thickness of the transverse carpal ligament.

3.5. Effects of ultrasound-guided needle-knife therapy on secondary outcomes

The secondary outcomes mainly consist of 2 parameters: clinical effectiveness rate and clinical cure rate. In this study, a total of 13 articles,^{[18–21,23–30,32]} respectively, compared clinical effective rate, clinical cure rate in CTS patients treated with ultrasound-guided needle-knife therapy with those in the control group. Test for overall effect showed that ultrasound-guided needle-knife therapy significant increased clinical effective rate (MD = 1.14, 95% CI 1.09 to 1.20, P < .00001; I² = 46%) and clinical cure rate (MD = 1.69, 95% CI 1.42 to 2.00, P < .00001; I² = 46%) compared with those of the patients in the control group (Fig. 7).

Figure 7.

Meta-analyses of the effect of ultrasound-guided needle-knife therapy on clinical effective rate and clinical cure rate compared with the control group.

3.6. Sensitivity analysis

Sensitivity analyses on the outcomes (VAS, wrist function, SCV, DML, CSA, TTCL) that included more than 10 items for comparison were conducted by removing each comparison to explore the sources of heterogeneity further. The pooled effect values of all outcomes were consistent with the original analysis, and the single study had little effect on the pooled results, indicating that the overall results of this study were reliable.

3.7. Publication bias test

Publication bias of all outcomes with high heterogeneity (VAS, wrist function, SCV, DML, CSA, TTCL) was examined by Egger test, for which more than 10 items were included in the comparison. The study results are shown in Table 3. The results showed no publication bias (P > .05) for all outcomes except for the VAS and CSA. The effect of publication bias of the VAS and CSA were further evaluated using the trim and fill method. The results suggest that the pooled effect value and significance of the VSA not change before and after trim and fill except for the CSA, indicating that the results of this study were reliable.

Table 3.

Publication bias test for primary parameters.

Outcomes	t-value	P-value
VAS	−3.15	.010
Wrist function	−1.09	.300
SCV	0.72	.498
DML	−1.86	.113
CSA	−5.74	.001
TTCL	−2.17	.096

CSA = cross section area, DML = distal motor latency, SCV = sensory conduction velocity, TTCL = thickness of the transverse carpal ligament, VAS = visual analogue scale.

4. Discussion

To our knowledge, this is the first meta-analysis that summarizes ultrasound-guided needle-knife therapy in patients with CTS. Previous reviews have examined the results of ultrasound-guided intervention on patients with CTS, such as ultrasound-guided corticosteroid injection^[34] and ultrasound-guided perineural injection,^[35] but none has focused on ultrasound-guided needle-knife therapy for CTS patients. Therefore, this review collated the evidence from a large number of trials, which evaluated the effect of ultrasound-guided needle-knife therapy on CTS patients. In this review, we reviewed 17 articles, including 996 patients with CTS. The results of this systematic review reveal that ultrasound-guided needle-knife therapy is effective for reducing pain intensity, TTCL, and it also improve wrist function, nerve conduction, clinical effective rate, and clinical cure rate compared with control in patients with CTS.

In traditional Chinese medicine, CTS can be classified into the category of “meridian tendon disease” and “arthralgia disease.” The pathogenesis of CTS is that the healthy qi is not solid, the muscles and bones are strained, the wrist meridian tendons are overstrained, and then the invasion of cold and dampness causes the wrist vein to be blocked, the qi and blood are not smooth, the channels are lost, and if the disease enters the collaterals for a long time, the qi and blood are consumed; the muscle is lost in nourishing, which will lead to local numbness, muscle weakness, and pain.^[36] Therefore, the main principles of traditional Chinese medicine treatment of CTS are dredging meridians, regulating qi, nourishing menstrual blood, reducing swelling, and relieving pain. Needle knife therapy integrates the characteristics of the western scalpel with traditional Chinese acupuncture techniques to provide better treatment for soft tissue diseases, which is the concept of “meridian tendon disease” in Chinese medicine theory. The root cause of CTS is that the median nerve suffers from the compression of the transverse ligament of the wrist in the carpal tunnel. Needle knife therapy is to release the myofascial membrane and muscle tissue by cutting and stripping, so as to improve the blood microcirculation and metabolism in the affected area and restore its original dynamic balance.^[37] However, the traditional needle-knife therapy treatment is carried out in the blind state of the surgeon, which inevitably causes damage to the surrounding tissues and nerves, which is easy to make the release incomplete and the curative effect is affected. The development of ultrasonic visualization technology may provide a safer treatment method of CTS by drug injection,^[37] needle-knife,^[38] and other means,^[39] which is beneficial to the improvement of its therapeutic effect. In view of the results, our meta-analysis shows that ultrasound-guided needle-knife technique significantly reduces pain, improves median nerve conduction, improves wrist function, and increases clinical effectiveness and cure rates in patients with CTS. This is consistent with the results of previous studies,^[40] proving that small needle-knife treatment is a safe and effective minimally invasive treatment method. Under the guidance of ultrasound technology, the operator can intuitively and clearly observe and adjust the tip of the needle and the direction of the needle and knife, avoiding large blood vessels, normal nerves, tendons, etc, and the positioning is more accurate, which can effectively avoid the needle and knife loosening and drug injection treatment process caused by the medical origin of the nerve injury, and at the same time, needle-knife therapy can significantly promote the circulation of meridians, regulate the flow of qi and blood, nourish the menstrual blood, and reduce swelling and relieve pain in patients with CTS, thus effectively improving the clinical effect. This may be the mechanism of ultrasound-guided needle-knife technology for the treatment of CTS patients.

4.1. Limitations

Although we have a comprehensive analysis and assessed all eligible studies, it still has some limitations in this systematic review and meta-analysis. First, from the results of the statistical heterogeneity study of this meta-analysis, the included studies have shown from moderate to high heterogeneity. Some studies showed only randomized trials but no specific methods of random sequence generation, randomized control trials of allocation concealment, or blinding of outcome assessment. Methodological quality of some of the included randomized control trials was low and they may have a high risk of bias. Second, despite the clinical use of ultrasound-guided needle-knife technology, the lack of randomized clinical trials leads to pull different needle-knife techniques under the same concept and thus to increase methodological heterogeneity. Finally, the number of sessions and total duration of treatment varied between studies due to the variability of the technique also contributed somewhat to the high degree of heterogeneity in the study results.

5. Conclusion

This study highlights that ultrasound-guided needle-knife technology have significant effectiveness on pain, wrist function, nerve conduction, ultrasonic detection indicators (CSA, TTCL), clinical effective rate, and clinical cure rate for patients with CTS.

International Prospective Register of Systematic Reviews (Identifier: CRD42025643362).

Author contributions

Conceptualization: Fang Tang, Pincao Gao.

Data curation: Fang Tang, Jiatao Zhang, Pincao Gao, Qiaoxia Zhang, Xiang Li.

Methodology: Fang Tang, Shenyi Lu, Jiatao Zhang, Qiaoxia Zhang, Xiang Li.

Project administration: Xiang Li.

Software: Fang Tang, Jiatao Zhang, Pincao Gao, Qiaoxia Zhang, Xiang Li.

Writing – original draft: Fang Tang, Jiatao Zhang.

Writing – review & editing: Shenyi Lu, Pincao Gao.

Supplementary Material

medi-104-e44158-s001.pdf ^{(1.3MB, pdf)}