An Incision-less Ultrasound-guided Carpal Tunnel Release Technique.

Ultrasound guidance in the operative treatment of carpal tunnel syndrome is gaining in popularity as it noninvasively provides the surgeon with a real-time high-resolution overview of anatomic structures. A new incision-less approach to achieve a division of the transverse carpal ligament has been developed that combines ultrasound guidance with cannulated needles and a thread. Conceptually, an abrasive thread is looped percutaneously around the ligament while avoiding injury to neurovascular structures, the palmar aponeurosis, and skin. The thread is positioned using 2 puncture sites and a contoured Tuohy needle under ultrasound visualization. With a minimal injury to surrounding structures, this approach is designed to minimize recovery time and decrease pillar pain. This article will provide a step-by-step overview of the technique and includes a review of clinical outcomes published so far.