Ultrasound-guided, Percutaneous Carpal Tunnel Release


With surgical access of just 2 millimeters these new procedures are the least invasive on the market by a wide margin.

Coda CTR Minimally invasive Carpal Tunnel Release Surgery

Patient immediately after a carpal tunnel release procedure using CODA CTR. Note the remarkably small skin punctures (instead of a large incision).

Carpal tunnel release surgery with CODA CTR™ or MANOS CTR™ is the least invasive surgical option available. Introduced in 2010, the procedure has quickly become popular, with thousands of procedures performed to date. Clinical papers have found that the new procedure is just as safe and effective as traditional procedures.

Carpal Tunnel Recovery Times

The minimally invasive carpal tunnel release surgery provided by the use of CODA CTR™ / MANOS CTR™ typically provides patients with full relief from carpal tunnel syndrome pain and numbness with a fast recovery time. The return to work time for a CODA CTR or MANOS CTR procedure can be a little as 48 hours. The typical return to work time range is 2 to 14 days, with a high percentage of patients returning to work the same week of surgery. Considering the average return to work time for an open carpal tunnel release is 54 days you can see why many patients are choosing this new procedure.1


Aside from the fast recovery this new procedure offers the following advantages:

  • Short process: The procedure itself is normally 10 to 15 minutes per hand.
  • One hand or two: Patients with bilateral carpal tunnel syndrome, i.e. in both hands, can often have both hands treated in a single visit to the operating room.
  • Stay awake: Patients typically stay awake during the procedure, which only local anesthesia, typically lidocaine, to numb the hand and wrist. Patients may also be given sedation for their comfort and relaxation during the short procedure.
  • Better asthetics: Because the surgery is performed through a 2mm puncture instead of a large incision there are typically no stitches and minimal, if any, visible scars afterwards.
  • Light bandage + Band-aids: Patients typically wear a light dressing for the first a day or two whereas other procedures often require a heavy bandage and may isolate the hand in a splint for up to two weeks.

The CODA CTR / MANOS CTR Procedure

Coda CTR Manos CTR - ultrasound guided carpal tunnel release surgery

Ultrasound technology provides a wide and clear view of all of the structures inside the carpal tunnel.

1. The surgeon uses ultrasound and anatomical landmarks to determine the surgical entry and exit points.
2. The surgeon makes a 2 millimeter “skin nick,” a small puncture through the skin and fascia, at the base of the wrist.
3. Using ultrasound the surgeon inserts a slender, blunt probe.  The probed is gently advanced to create a pathway for the Coda CTR / Manos CTR surgical device.  Afterwards the probed is removed.
4. The CODA CTR / MANOS CTR device is inserted through the 2mm access point and advanced through the carpal tunnel.  The device is completely blunt during guidance and positioning.  When properly positioned the tip of the device will “tent” the skin of the hand at the exit point previously marked.  The device will also be immediately under the transverse carpal ligament.
Patient undergoing a minimally invasive carpal tunnel release with CODA CTR.

Patient undergoing a minimally invasive carpal tunnel release with CODA CTR.

5. The surgeon advances a slide lever on the CODA CTR / MANOS CTR device.  This exposes a uni-directional, micro-serrated cutting surface next to the transverse carpal ligament. It also advances a sharp wire through the palm to laterally stabilize the device and define the cutting plane.
6. The surgeon presses the ligament into the cutting surface with his finger and small vertical motions with the device to transect the ligament.  The device provides excellent auditory and tactile feedback.  In other words, the surgeon can both hear and feel the cutting of the ligament.  The surgeon periodically checks his progress using ultrasound.  The goal is of the surgeon is to completely transect the ligament without cutting or damaging the surrounding tissue.
7. Once the ligament has been cut completely (a “full release”) the surgeon retracts the cutting surface and gently removes the device.
8. The puncture in the palm is so small it typically closes by itself.  The puncture in the wrist is covered with a Steri-Strip™ bandage.  A light dressing is applied to for light compression on the ligament.
9. Patients are instructed to use their hands as they normally would but to avoid heavy tasks during the healing process. Many patients return to work in days.

What’s in a name?

The two brand names are for identical devices and procedures. We recommend patients choose whatever version is covered by their insurance plans or minimizes out of pocket cost. The procedures are typically covered by most PPO insurance plans as well as Medicare.

Free Carpal Tunnel Consultation & Referral

Manos CTR logo 140x85Coda CTR Logo 140x85Do you suffer from Carpal Tunnel Syndrome?  Get a Free Consultation with one of our Carpal Tunnel Care Coordinators and a Free Referral to a doctor specializing in CODA CTR and MANOS CTR minimally-invasive procedures.

Get a FREE Carpal Tunnel Consultation & Doctor Referral

CODA CTR / MANOS CTR Image Gallery

Manos CTR - Distal view retracted
A distal view of the MANOS CTR surgical device in the blunt, retracted position.

Manos - Superior-Distal view deployed with cap
The MANOS CTR carpal tunnel release system with the cutting surface exposed.

Manos CTR - Profile Retracted
Side view of the MANOS CTR device. The cutting surface is retracted.

Manos CTR - Profile Deployed - No Cap
Side view of the MANOS CTR device with the cutting surface exposed after thumb slide level advancement.

Manos CTR - Closeup of Cutting Surface Deployed
A close up of the MANOS CTR cutting surface. It is exposed only after positional safety checks have been completed. The micro-serrated teeth are uni-directional and cut only when pulled proximally, i.e. towards the arm. This gives the surgeon extremely precise control of the cutting action.

Side view illustration of the surgical device during a minimally invasive carpal tunnel release procedure. Side view illustration of the MANOS CTR surgical device during a minimally invasive carpal tunnel release procedure.

Top view illustration of the surgical device during a carpal tunnel release procedure.
Top view illustration of the MANOS CTR surgical device during a minimally invasive carpal tunnel release procedure.

Carpal Tunnel Surgery