Abstract
BACKGROUND: Carpal Tunnel Syndrome (CTS) remains a pervasive condition, often resulting in functional impairment and pain. This study examines whether ultrasound guidance enhances the efficacy and safety of corticosteroid injections for CTS compared to traditional injections based on anatomical landmarks. METHODS: This meta-analysis was conducted in accordance with PRISMA guidelines. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library up to September 19, 2023. Randomized controlled trials (RCTs) comparing ultrasound-guided(US) versus landmark-guided(LM) corticosteroid injections for CTS were included. Data were synthesized using a random-effects model. RESULTS: Eight RCTs were included in the analysis. US was associated with a significant reduction in BCTQ symptom severity scores (Standardized Mean Difference [SMD] = -0.32, 95% CI -0.44 to -0.20; I²=0%) and functional status scores (SMD = -0.21, 95% CI -0.31 to -0.10; I²=0%). Nerve injury events were rare; while the direction of effect favored US, the evidence was too sparse to permit a reliable pooled estimate. CONCLUSIONS: US corticosteroid injections provide modest, consistent improvements in symptoms and function over landmark techniques. Safety signals directionally favor US, but adverse-event data are sparse and not definitive.