TechniquesAn Incision-less Ultrasound-guided Carpal Tunnel Release TechniqueSchrier, Verena J.M.M. MD*; Shin, Alexander Y. MD†; Brault, Jeffrey S. DO‡Author Information Departments of *Orthopedic Surgery †Neurosurgery ‡Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding. Address correspondence and reprint requests to Jeffrey S. Brault, DO, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905. E-mail: [email protected]. Techniques in Hand & Upper Extremity Surgery: March 2021 - Volume 25 - Issue 1 - p 14-19 doi: 10.1097/BTH.0000000000000305 Buy SDC Metrics Abstract 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. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.