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Ultrasound-guided Carpal Tunnel Release: Interim 6-month Results from the MISSION Registry
Ashley L Pistorio, MD, MS
1, Victor M Marwin, MD, MBA
2, John J Callahan, MD
3, Stuart M Hilliard, MD
4, Johnny T Nelson, MD
5, Alan J Micev, MD
6, Paul Perry, MD
7, Larry E Miller, PhD
8; James F Watt, DO
9(1)Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, (2)Bluegrass Orthopaedics, Lexington, KY, (3)Buffalo Surgery Center, Amherst, NY, (4)North Texas Hand Center, Denton, TX, (5)The Bone and Joint Surgery Clinic, Raleigh, NC, (6)Hand Center of Nevada, Las Vegas, NV, (7)Tristate Orthopaedics, Evansville, IN, (8)Miller Scientific, Johnson City, TN, (9)Orthopedic Associates, Fort Walton Beach, FL
Introduction: Ultrasound-guided carpal tunnel release with balloon dilation (UGCTR) is a minimal incision technique for treating carpal tunnel syndrome. This study reports the interim 6-month outcomes from the ongoing MISSION registry in patients treated with UGCTR in routine clinical practice.
Materials & Methods: This prospective observational multicenter registry included adult patients diagnosed with carpal tunnel syndrome who failed conservative management and were subsequently treated with UGCTR. Main outcomes included time to return to normal activities and work, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), pain severity scores, health-related quality of life via EQ-5D-5L, adverse events, and reoperations. Patients are followed in the registry for 2 years; this analysis included outcomes for those with available data through 6 months.
Results: A total of 900 patients (1095 hands) were treated at 22 sites across the United States between February 2024 and May 2025. Most procedures (93.1%) utilized the WALANT technique and the mean incision length was 4.8 ± 1.3 mm. The median time to resume normal activities was 3 days (interquartile range: 1-5 days) and time to return to work was 4 days (interquartile range: 2-7 days). At the time of analysis, 495 patients had completed the 6-month follow-up. All patient-reported outcomes significantly improved over 6 months, with mean changes from baseline of -1.67 (95% CI: -1.71, -1.63) for BCTQ-SSS, -1.05 (95% CI: -1.10, -1.01) for BCTQ-FSS (Figure 1), -3.9 (95% CI: -4.1, -3.7) for pain severity, and 0.15 (95% CI: 0.14, 0.16) for EQ-5D-5L (all p<0.001). Among all patients, no serious adverse events occurred, 5 (0.6%) non-serious adverse events (minor bleeding, hematoma, pillar pain, persistent symptoms, superficial infection) were reported, and 1 (0.1%) revision surgery was performed for recurrent symptoms during follow-up.
Conclusions: This study provides real-world evidence that UGCTR can be safely performed with rapid recovery and clinically significant symptom and functional improvement through 6 months of follow-up. These findings support the use of UGCTR as a valuable option in the treatment armamentarium for carpal tunnel syndrome.
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