ObjectiveTo compare the effectiveness of ultrasound‐guided injections to blind injections in the treatment of carpal tunnel syndrome (CTS) in a large community‐based cohort.MethodsThis study evaluated residents of Olmsted County, Minnesota, treated with a corticosteroid injection for CTS between 2001 and 2010. The proportion of patients receiving retreatment and the duration of retreatment‐free survival between blind and ultrasound‐guided injections were compared. Propensity score matching was used to control for confounding by indication.ResultsIn the matched data set consisting of 234 (of 600) hands treated with a blind injection and 87 (of 89) ultrasound‐guided injection cases, ultrasound guidance was associated with a reduced hazard of retreatment (hazard ratio 0.59 [95% confidence interval (95% CI) 0.37–0.93]). In addition, ultrasound guidance was associated with 55% reduced odds of retreatment within 1 year compared to blind injections (adjusted odds ratio 0.45 [95% CI 0.24–0.83]).ConclusionThis study indicates that ultrasound‐guided injections are more effective in comparison to blind injections in the treatment of CTS.