08 Jul Ultrasound-Guided Carpal Tunnel Release Outperforms Endoscopic Approach in Largest Ever Prospective Registry Study
MedicalResearch.com Interview with:
Dr. Marwin
Victor Marwin, M.D.
Vero Orthopaedics
3955 Indian River Blvd, Vero Beach, FL 32960
Responses provided on behalf of Sonex Health (sonexhealth.com)
MedicalResearch.com: What is the background for this study? Would you briefly explain what are the symptoms and complications of carpal tunnel syndrome and who is more prone to developing this condition?
Dr. Marwin: The MISSION registry is the largest ever prospective, multicenter study that is collecting real-world outcomes of patients suffering from carpal tunnel syndrome (CTS). More specifically, it looks at patients with CTS who are treated with an ultrasound-guided carpal tunnel release (UGCTR) procedure using Sonex Health’s commercially available device, UltraGuideCTR, endoscopic carpal tunnel release (ECTR), or open carpal tunnel release (OCTR) in routine clinical practice in the United States. The goal of the MISSION registry is to compare symptom relief, functional outcomes, pain, quality of life, and patient satisfaction among the different procedural approaches to treat carpal tunnel syndrome.
CTS is one of the most frequently reported occupational injuries and the second leading cause of lost work time. In fact, it typically leads to more lost days per claim than almost any other work-related injury. Common symptoms include severe wrist and/or hand pain, numbness and tingling, making simple tasks including typing or gripping tools nearly impossible without treatment. People who work in jobs requiring repetitive hand use, forceful gripping, and vibrating tools are at greatest risk, including those in manufacturing and assembly, construction and mechanical, office and tech, beauty and healthcare, and food service and processing. Related research on carpal tunnel procedures performed in the office setting has previously been covered on MedicalResearch.com.
MedicalResearch.com: What are the main findings? How is ultrasound-guided release an improvement over the traditional endoscopic method?
Dr. Marwin: The MISSION registry is significant because the results demonstrate real-world, patient-reported experiences across the largest set of CTS patients in a single study, establishing a new benchmark for safety, efficacy, and patient outcomes in carpal tunnel release procedures. Key findings from the patients treated with UGCTR include:
- Symptoms, function, and pain rapidly improved and remained significantly improved compared to the baseline at six months.
- The median time to resume normal activities was three days and the time to return to work was four days.
- At six months, patient satisfaction among all treated hands was 89.9%.
- 82.1% of procedures were performed using only local anesthesia (i.e. wide awake local anesthesia no tourniquet — WALANT).
- Procedures were performed through a small wrist incision (mean 5 mm) that did not require sutures (90% suture-free closure).
- 22% of patients underwent simultaneous bilateral procedures, with clinical outcomes comparable to those reported for unilateral procedures.
When comparing UGCTR and ECTR head-to-head, UGCTR resulted in significant patient advantages over ECTR. Specific findings include:
- 85.5% of UGCTR procedures were performed using WALANT anesthesia compared to 30.1% for ECTR.
- UGCTR was associated with a shorter incision (5 mm) compared to ECTR (12 mm) and less frequently required suture closure (11% versus 100%).
- Fewer patients used opioids for pain control following UGCTR versus ECTR (10.3% versus 39.7%).
- At three months, overall satisfaction was higher with UGCTR compared to ECTR (92.1% vs. 83.6%).
- At three months, wound satisfaction favored UGCTR, and UGCTR patients reported significantly less wound-related symptoms.
MedicalResearch.com: What should readers take away from your report?
Dr. Marwin: The findings of this study demonstrate meaningful clinical outcomes and practical and economic benefits to patients, providers, and healthcare systems. For patients, the short recovery period and early return to work observed after UGCTR may lessen the financial impact of time away from employment, which is particularly relevant given that nearly two-thirds of the cohort were employed at the time of treatment. In terms of providers, UGCTR resulted in high satisfaction rates and a low risk of complications, making it a strong option for their patients. From a healthcare system perspective, techniques that enable rapid functional recovery without compromising safety may reduce overall healthcare expenditures given the CTS-related healthcare costs of over $2 billion annually in the U.S.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Marwin: UGCTR using UltraGuideCTR sets the standard for the future of carpal tunnel release treatment. The results highlight the ability to perform a minimally invasive surgery with local anesthesia in an office-based setting, without the use of a tourniquet. Now with comprehensive reimbursement in all sites of service including the office, this minimally invasive technique can be delivered in a more efficient setting. As hand surgeons, we have a choice of which environment to perform UGCTR in, and it is my hope that other surgeons take full advantage of this technique and transition to the office where patients prefer to have this procedure.
This published data further strengthens the UGCTR evidence base, adding to 18 peer-reviewed publications representing more than 1,400 patients and 2,000 hands. This includes studies comparing UGCTR to open carpal tunnel release (OCTR) and UGCTR to ECTR.
Disclosure: Dr. Marwin is a consultant for and has received research funding from Sonex Health.
Citation:
Marwin VM, Nelson JT, Watt JF, et al. Prospective Multicenter Propensity Score-matched Comparison of Ultrasound-guided Versus Endoscopic Carpal Tunnel Release. J Hand Surg Glob Online. 2026 Feb 27;8(3):100974. doi: 10.1016/j.jhsg.2026.100974. PMID: 41799667; PMCID: PMC12966659.
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Last Updated on July 9, 2026 by Marie Benz MD FAAD