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Dec 24, 2023

Journal Watch: Safety and Efficacy of Ultrasound Guided Carpal Tunnel Release with Sonex

Carpal tunnel syndrome is the most common entrapment neuropathy (Atroshi et al) with 1.9% of men and 4.1% of women developing carpal tunnel syndrome in their lifetime (Pourmemari et al). In patients with severe carpal tunnel syndrome or when symptoms do not respond to conservative management then a carpal tunnel release provides symptomatic relief in most patients (Shi and MacDermid).

An estimated 500,000 carpal tunnel releases are performed annually in the United States (Pourmemari et al). Despite carpal tunnel release being the most common surgery performed, many patients who are surgical candidates defer the procedure.

In a case series by Joseph et al. (2020), the author described their experience transitioning from the MANOS device (Thayer Intellectual Property, Inc, San Francisco, CA) to the Sonex device (Sonex Health, Inc, Rochester, MN). At the time of publication, this study represented the largest published case series and the procedure was performed by a family medicine physician with additional training in ultrasound guided procedures and primary care sports medicine.

The study included 22 patients (35 wrists) with carpal tunnel syndrome. The procedure was performed without general anesthesia in all cases, and no complications were reported. The ultrasound also allowed for identification of a Berrettini communication and allowed the author to avoid cutting this nerve variant.

All patients had a significant improvement in symptoms and function using the QDASH, BCTQ-SS AND BCTQ-FS scores as early as 1 to 2 weeks after the surgical release with the Sonex device. There was a high degree of patient satisfaction reported.


The authors found an accelerated recovery after the carpal tunnel release using ultrasound guidance and the Sonex device when compared to the literature on the "mini-open" carpal tunnel release surgery. In addition, 63% of patients had a bilateral carpal tunnel release simultaneously. This was another advantage to this ultrasound guided procedure as bilateral simultaneous mini-open carpal tunnel releases can be temporarily disabling forcing patients to stage the procedures.


Atroshi I, Englund M, Turkiewicz A, Tägil M, Petersson IF. Incidence of physician-diagnosed carpal tunnel syndrome in the general population. Arch Intern Med. 2011 May 23;171(10):943-4.

Joseph AE, Leiby BM, Beckman JP. Clinical Results of Ultrasound-Guided Carpal Tunnel Release Performed by a Primary Care Sports Medicine Physician. J Ultrasound Med. 2020 Mar;39(3):441-452.

Pourmemari MH, Heliövaara M, Viikari-Juntura E, Shiri R. Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors. Muscle Nerve. 2018 Oct;58(4):497-502.

Shi Q, MacDermid JC. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? A systematic review. J Orthop Surg Res. 2011 Apr 11;6:17.

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