Threaded Carpal Tunnel Release (TCTR)

What makes this different

Most patients come in thinking carpal tunnel means surgery — either an open incision at the palm or an endoscopic approach with a camera and a small cut at the wrist. TCTR is neither of those things. It's an office-based, incisionless procedure that releases the transverse carpal ligament using a specialized needle. No operating room. No general anesthesia. No stitches. No weeks of restricted activity while a surgical wound heals.

The thing that makes this possible — and safe — is real-time ultrasound guidance throughout the entire procedure. This is not a blind technique. I can see the median nerve, the flexor tendons, and the transverse carpal ligament on the ultrasound screen from the moment the needle enters the skin until it's done.

How we know you're a candidate first

I don't skip the diagnosis. Before anyone is offered TCTR, we confirm carpal tunnel syndrome with EMG and nerve conduction studies. These tests do two things: they tell us whether the diagnosis is actually carpal tunnel syndrome (and not something else mimicking it), and they tell us the severity of nerve involvement.

Severity matters here. Mild to moderate CTS — slowed conduction velocities, prolonged distal latencies, but preserved motor function and nerve fiber integrity — is the sweet spot for TCTR. These patients respond well. Severe CTS with significant axonal loss, marked muscle wasting at the thumb (thenar atrophy), or profound weakness tells a different story. At that stage, the nerve has been compressed long enough that structural damage has occurred, and the priority shifts to getting surgical decompression done as quickly as possible. If that's your picture, I'll tell you honestly and refer you appropriately. TCTR is not the right answer for everyone.

The procedure

The whole thing takes about 20 to 30 minutes from start to finish, including setup and aftercare. You're awake. No IV, no sedation, no fasting required.

I inject local anesthetic at the wrist to numb the area — this is the most uncomfortable part, and it's brief. Once you're numb, I use ultrasound to map the anatomy: the median nerve, the transverse carpal ligament, and the surrounding structures. I then perform hydrodissection — injecting a small volume of fluid to create a safe plane between the median nerve and the overlying ligament. This physically separates the nerve before any cutting happens, which is a critical safety step.

From there, a specialized threaded needle is passed through a small skin entry point and positioned beneath the transverse carpal ligament under continuous ultrasound visualization. The ligament is then released along its length. I'm watching the screen the entire time to confirm position and progress.

When the release is complete, the needle comes out. There's no incision to close. A small bandage covers the entry point. That's it.