Carpal Tunnel & Trigger Finger Release

Two office procedures that use real time ultrasound imaging to treat the two most common compressive hand conditions.

In traditional hand surgery, the incision has to be large enough for the surgeon to see the anatomy directly. That requirement is what drives the incision size, the operating room setting, and the recovery time.

Ultrasound changes that. High resolution imaging shows the nerve, tendons, and blood vessels on a screen in real time, so the physician can see everything needed without opening the hand to look at it. The incision only has to be large enough to admit the instrument.

What it treats

Carpal tunnel syndrome

The median nerve travels through a tunnel at the wrist, formed by the wrist bones underneath and a thick band of tissue across the top called the transverse carpal ligament. When that tunnel becomes tight, the nerve is compressed. The procedure divides the ligament to give the nerve room. The ligament is not repaired, and the space it leaves behind is the point of the operation.

Symptoms patients recognize:

• Numbness and tingling in the thumb, index, and middle fingers

• Symptoms that wake them at night, or flare while driving or holding a phone

• Shaking the hand out to make it feel better

• Weakness, clumsiness, or dropping objects

• In advanced cases, visible thinning of the muscle at the base of the thumb

Trigger finger

The tendon that bends a finger glides through a series of tunnels along the finger and palm. The first of these, called the A1 pulley, can thicken and narrow, causing the tendon to catch as it passes through. The procedure opens that pulley so the tendon glides freely again.

Symptoms patients recognize:

• A finger or thumb that clicks, catches, or locks when bending or straightening

• A tender lump or soreness in the palm at the base of the affected finger

• Stiffness that is worst in the morning

• Sometimes needing the other hand to straighten the finger

Who is a good candidate

Good candidates generally include patients who:

• Have a confirmed diagnosis, supported by examination and by ultrasound or nerve testing

• Have already tried conservative treatment such as a night splint, activity changes, or a corticosteroid injection, and either did not improve or improved only temporarily

• Have numbness that has become constant rather than coming and going

• Are developing grip weakness or thinning of the thumb muscle, which signals that waiting carries a cost

• Have a trigger finger that locks regularly or will not fully straighten

• Want to avoid general anesthesia, whether by preference or because of other medical conditions

• Cannot afford weeks away from work or from caregiving responsibilities

• Have both hands affected, since bilateral carpal tunnel can often be treated in a single visit

Patients who are not good candidates, or who need a different conversation:

• Anyone who has not yet tried conservative treatment. Many patients improve without a procedure, and that is where we start

• Patients who have had a previous release at the same site

• Patients with unusual anatomy, a mass in the tunnel, or anatomic variants that make the ultrasound guided approach less safe

• Certain inflammatory or systemic conditions affecting the hand

• Patients whose symptoms are actually coming from the neck or elsewhere along the nerve, which is common and is one reason the evaluation matters

Every patient needs an examination and imaging before candidacy can be determined. Some patients are better served by traditional surgery, and in those cases we say so and help them get to the right surgeon.

Benefits

Faster return to normal life. This is the difference patients care about most. In the MISSION registry, a study of 887 patients and 1,082 hands across 22 sites in the United States published in June 2026, the median time back to normal daily activities was 3 days and the median time back to work was 4 days. By two weeks, 92.3 percent of patients had returned to normal activities and 80 percent had returned to work. Return to work varied by job type, at 3 days for desk based work and 5 days for manual work.

No general anesthesia. Local numbing medicine only. This removes an entire category of risk, eliminates the pre operative workup and fasting, and means the patient drives themselves home.

A much smaller incision. Typically under 5 mm at the wrist, usually closed with an adhesive strip. Better cosmetic result and less scar tenderness in the palm, which is a common complaint after traditional open release.

Immediate motion. Patients move their fingers right away. Formal hand therapy is usually not required, and most patients manage discomfort with medications available without a prescription.

Lower cost. Performing the procedure in the office rather than a hospital operating room removes facility fees and anesthesia charges.

Results that hold up. A two year study published in September 2026, following 149 patients and 226 hands treated in an office setting, found durable symptom relief, consistently high satisfaction, and no repeat procedures for persistent or returning symptoms.

A strong safety record. The MISSION registry reported no intraoperative complications and no serious adverse events. ECRI, an independent health technology assessment organization, has issued a favorable evidence rating for the carpal tunnel device.