This minimally invasive treatment uses just a needle and a thread to release the transverse carpal ligament; there is no blade or scalpel involved. It is performed in the office, under ultrasound guidance using only local anesthesia, in an average of 15 minutes. Patients are generally able to return to their normal activities of daily living that day and depending on their job return to work the next day or next week. Learn more HERE.

The Benefits

• No incision. No blade. No scalpel. No sutures.
• No general anesthesia. No nerve block
• In the office
• Faster return to work (as little as 24 hours)

Where is it being performed?

The technique was created by Dr. Danzhu Guo MD and Dr. Danqing Guo MD, two former surgeons from China who now practice at BayCare in Green Bay, Wisconsin (BayCare Clinic). There they have completed roughly 2,000 successful cases. Aside from their office, this procedure is currently only performed at the Mayo Clinic (Mayo Clinic News Release ; Mayo Clinic Video Preview), and a handful of private practices around the country. Dr. Latzka recently traveled to Green Bay to learn directly from the Guo brothers.

The following video produced by the Guo brothers, illustrates the procedure. First, the anatomy of the wrist is precisely mapped using ultrasound, which also provides guidance for a thin needle that is passed through the palm, under the transverse carpal ligament, and exits through the wrist. Through this needle a thread is passed. The needle is then removed and reinserted, this time over the TCL, loping the thread around the ligament. The thread is then pulled in a back and forth motion, and akin to twine cutting cheese, the ligament is divided, releasing the pressure on the median nerve. The thread is then removed bandages applied.

https://youtu.be/B7Xb_XiRsHs?feature=shared&t=29

The Evidence:

• In 2015, Guo et al publish the original Thread Carpal Tunnel Release, which was performed proximally to distally (Guo 2015). They later published modifications to the technique, including altering the direction from distal to proximal (Guo 2017), and including the hydrodissection of the TCL from the superficial palmar aponeurosis. (Guo 2021).
• In 2021, a retrospective safety review of 827 procedures found the procedure to be safe and effective, with office workers returning to work on postop day 1 (Guo 2021)
• In 2022, a Mayo Clinic study compared the Thread Release to Open Carpal Tunnel Release, and found that the Thread group returns to work 3x faster than the surgical group. (Asserson 2022)
• In 2023, a Mayo Clinic study reported data on its first 300 cases. The time to complete the procedure averaged 18 minutes for the first 25 cases and improved to 8.6 minutes for the last 25 cases. (North 2023)
• In 2024, a retrospective cohort study of patients with severe carpal tunnel syndrome reported 82 Thread releases with 2 year outcomes showing no recurrence. (Kim 2024)
• Additional studies are cited below

REFERENCES:

Akhoondinasab MR, Saraee A, Akbari H, Forghani SF, Naderi B. Aesthetic and Functional Outcomes of Open Carpal Tunnel Release and Thread Carpal Tunnel Release: A Randomized Clinical Trial. Indian Journal of Plastic Surgery. 2024 Jan 15.

Asserson, Derek B., et al. "Return to work following ultrasound guided thread carpal tunnel release versus open carpal tunnel release: a comparative study." Journal of Hand Surgery (European Volume) 47.4 (2022): 359-363.

Burnham RS, Loh EY, Rambaransingh B, Roberts SL, Agur AM, Playfair LD. A controlled trial evaluating the safety and effectiveness of ultrasound-guided looped thread carpal tunnel release. Hand. 2021 Jan;16(1):73-80.

Guo D, Guo D, Guo J, Schmidt SC, Lytie RM. A clinical study of the modified thread carpal tunnel release. Hand. 2017 Sep;12(5):453-60.

Guo D, Yu T, Ji Y, Sun T, Guo J, Guo D. A non-scalpel technique for minimally invasive surgery: percutaneously looped thread transection of the transverse carpal ligament. Hand. 2015 Mar;10(1):40-8.

Guo K, McCool L, Wang H, Guo D, Guo D. The modified ultrasound-guided distal-to-proximal carpal tunnel injection with median nerve hydrodissection: a retrospective safety review of 827 procedures. Hand. 2021 May;16(3):407-9.

Kim IJ, Kim JM. Long-Term Outcomes of Ultrasound-Guided Thread Carpal Tunnel Release and Its Clinical Effectiveness in Severe Carpal Tunnel Syndrome: A Retrospective Cohort Study. Journal of Clinical Medicine. 2024 Jan 2;13(1):262.

North TJ, Asserson DB, Shin AY, Brault JS. Thread carpal tunnel release: a retrospective review of the first 300 cases per formed at a tertiary medical centre. Journal of Hand Surgery (17531934). 2023 Oct 1;48(9).

Park J, Kim IJ, Park HY, Heo DJ, Kim JM. A clinical study of thread carpal tunnel release with a newly developed thread: A retrospective pilot study. PloS one. 2022 Oct 21;17(10):e0276630.

Schrier VJ, Shin AY, Brault JS. An incision-less ultrasound-guided carpal tunnel release technique. Techniques in Hand & Upper Extremity Surgery. 2021 Mar 1;25(1):14-9.