Relief from carpal tunnel & trigger finger — without open surgery.
Ultrasound-guided release performed right in our office, while you stay comfortably awake. A few millimeters. A few minutes. Back to the life you love in days.
- Tiny incision — usually no stitches needed
- Only local numbing (WALANT) — no IV, no sedation
- Diagnosed with ultrasound — often no painful EMG nerve test
- Most patients return to daily activities within days
Performed by Dr. Paul Morton & Dr. Ronnie Otieno · Oʻahu & the Big Island
Two of the most common hand problems — solved in the office
Carpal tunnel syndrome and trigger finger don’t have to mean a hospital, general anesthesia, or weeks on the sidelines. Using real-time ultrasound, Dr. Morton and Dr. Otieno release the exact structure causing your symptoms through an opening just a few millimeters wide.
Ultrasound-Guided Carpal Tunnel Release
Carpal tunnel syndrome happens when the median nerve is squeezed at the wrist, causing numbness, tingling, and night-time waking in the thumb, index, and middle fingers. The fix is to release the transverse carpal ligament — and ultrasound lets us do it through a tiny wrist incision while watching the nerve in real time.
- Diagnosed in-office with ultrasound — usually no painful EMG nerve test
- Releases the ligament without a large palm incision
- Real-time imaging helps protect the nerve, tendons & vessels
- Less scar tissue and pillar pain than traditional open surgery
- Back to typing, driving & daily tasks in just a few days
Ultrasound-Guided Trigger Finger Release
Trigger finger happens when a tendon catches as it passes through a tight pulley (the A1 pulley) at the base of the finger, causing painful clicking, catching, or a finger that locks down. Under ultrasound, Dr. Morton and Dr. Otieno release that pulley percutaneously — through a needle-sized opening, with no open incision.
- Frees the catching tendon at its source, the A1 pulley
- Percutaneous — most patients need no stitches at all
- Many patients can move the finger soon after the procedure
- An option when splinting or injections haven’t given lasting relief
Wide awake. Local anesthesia. No tourniquet.
WALANT is a modern, proven approach that lets us numb just the area we’re treating with a local anesthetic — the same family of medicine your dentist uses — so there’s no IV, no sedation, and no breathing tube.
You stay relaxed and awake the whole time. Because there’s no general anesthesia, there’s usually no fasting beforehand, no anesthesia recovery afterward, and in most cases you can drive yourself home and get on with your day.
No sedation
No IV and no breathing tube — just local numbing medicine.
No fasting
Eat normally beforehand; most patients drive themselves home.
Skip general anesthesia
Avoid the added risks and grogginess of going fully under.
Lower cost
Done in our office — no hospital or surgery-center facility fees.
From symptoms to relief in five simple steps
A clear, unhurried path — most patients go from first visit to feeling better faster than they expected.
Evaluation & ultrasound
Dr. Morton or Dr. Otieno confirms the diagnosis with in-office ultrasound — often without a painful EMG nerve test.
Numb the area
A gentle local anesthetic numbs just the hand or wrist — no IV, no sedation.
Guided release
Watching live ultrasound, the ligament or pulley is released in about 10–15 minutes.
Simple bandage
The tiny opening is closed with an adhesive strip — and you walk out the door.
Back to life
Use your hand right away for light tasks; most return to routine in 3–5 days.
A gentler path than open or endoscopic surgery
All three relieve the same underlying problem. Here’s how in-office, ultrasound-guided release compares with endoscopic and traditional open surgery.
| Ultrasound-GuidedIn-office · WALANT | EndoscopicOperating room | Open SurgeryHospital / ASC | |
|---|---|---|---|
| Incision | ~4–5 mm at the wrist | Small (palm/wrist) | Up to ~2 inches (≈22 mm) |
| Anesthesia | Local only — awake (WALANT) | Often sedation / general | Often sedation / general |
| Setting | Doctor’s office | Operating room | Hospital / surgery center |
| Stitches | Usually none | Typically required | Typically required |
| Scar & pillar pain | Minimal | Moderate | Larger scar, more pillar pain |
| Typical return to activity | ~2–3 days | Days to weeks | Several weeks |
| See the nerve in real time | Yes ✓ (ultrasound) | Limited (camera view) | Direct view only |
| Facility fees | Avoided | OR fees apply | OR / hospital fees |
Recovery times are typical ranges and vary by patient. Comparative figures are drawn from peer-reviewed ultrasound-guided CTR studies; Dr. Morton or Dr. Otieno will review which option is best for you.
Why real-time ultrasound matters
We can see everything — the whole time. High-resolution ultrasound shows the median nerve and its branches, the surrounding tendons, and nearby blood vessels live, throughout the procedure — including anatomical variations (like a persistent median artery or an extra nerve branch) that aren’t visible until it’s too late in other approaches. Traditional open surgery only reveals what’s exposed in the incision, and endoscopic surgery gives a limited camera view from beneath the ligament. Ultrasound lets us watch and protect these structures continuously while we release the exact spot causing your symptoms.
Less “pillar pain.” Pillar pain is lingering tenderness in the fleshy pads at the base of the palm — common for weeks to months after traditional open surgery. Because the ultrasound-guided release works through a tiny wrist opening and divides only the ligament (no large palm incision, far less tissue disruption), pillar pain is typically minimal.
The evidence behind ultrasound-guided release
Ultrasound-guided carpal tunnel release isn’t experimental — it’s supported by a large and growing body of peer-reviewed evidence, including a Level‑1 randomized trial.
ultrasound-guided releases performed with UltraGuideCTR since 2017.
clinical success rate reported across 30+ peer-reviewed publications (3,000+ hands).
median return to normal activity; median return to work of 3–5 days across multiple studies.
of wounds closed without sutures in a multicenter, office-based study (ROBUST).
our typical wrist incision versus the ≈22 mm palm incision of traditional open carpal tunnel surgery.
typically needed — discomfort is usually managed with acetaminophen or NSAIDs, with high patient satisfaction.
In a head-to-head randomized trial, patients treated with ultrasound guidance recovered significantly faster than those who had mini-open surgery, with smaller incisions and far less scar pain or sensitivity at one year — and no late complications in either group.
Figures from the UltraGuideCTR Clinical Summary (Sonex Health, 2025) and peer-reviewed studies including the TUTOR randomized trial, and the ROBUST and APEX multicenter registries. These figures pertain to ultrasound-guided carpal tunnel release; individual results vary. See the full clinical research at sonexhealth.com.
Watch the procedure & see us in action
A quick look at how ultrasound-guided release works, what to expect, and our team featured in the news. Tap any video to play.
Educational videos. Individual results vary — your evaluation with Dr. Morton will determine what’s right for you.
Could ultrasound-guided release help you?
Answer a few quick questions about your hand symptoms. You’ll get an instant, private read on how your symptoms compare — and what to do next.
Book directly with Dr. Morton or Dr. Otieno
You’re not booking a “free screening” with a salesperson — you’re scheduling with the physicians who actually care for you: a board-certified orthopedic surgeon and a fellowship-trained sports medicine specialist.
Dr. Paul Norio Morton, MD, FAAOS, FAAHKS
Dr. Paul Morton is a Hawaiʻi-born, board-certified and fellowship-trained orthopedic surgeon and the founder of Pacific Bone & Joint. He completed fellowship training in adult reconstruction at the University of Chicago and an AO Trauma fellowship at Charité – Universitätsmedizin Berlin, and was the first surgeon in Hawaiʻi fellowship-trained in robotic joint replacement. He brings that same precision and technology-driven approach to the hand — performing carpal tunnel and trigger finger release with wide-awake local anesthesia (WALANT) and real-time ultrasound, so patients get relief without the hospital, general anesthesia, or a long recovery. Patients consistently describe him as compassionate, thorough, and approachable.
Dr. Ronnie Otieno, DO
Dr. Ronnie Otieno is a fellowship-trained sports medicine physician who grew up in Kisumu, Kenya and trained at Washington University in St. Louis and the Kirksville College of Osteopathic Medicine (ATSU). He completed a family medicine residency at Creighton University in Phoenix and a sports medicine fellowship at MAHEC in Asheville, North Carolina. Focused on non-surgical orthopedic care and keeping patients active, he has extensive experience with ultrasound-guided procedures and injections — including PRP and carpal tunnel injections — and helps determine whether a non-surgical option or an ultrasound-guided release is the right next step for you.
Relief, in their words
Stories from patients treated with ultrasound-guided release — including Dr. Morton’s own patients and people across the country treated with the same UltraGuideCTR technique.
“I had a carpal tunnel release by Dr. Morton. I think he is one of the best doctors I have ever known — very compassionate and understanding. He takes his time listening and addresses every single concern.”
“Almost all of my symptoms stopped right away. There was no big scar and barely any downtime — I couldn’t believe how simple it was.”
“I went home within an hour and was back to work the next day. After living with numbness for years, the relief was almost immediate.”
“Within a week I was back to lifting weights and hitting golf balls. My only regret is that I didn’t do it sooner.”
Patient experiences with ultrasound-guided carpal tunnel release (UltraGuideCTR, Sonex Health). Individual results vary and are not a guarantee of outcome. More UltraGuideCTR patient stories →
Frequently asked questions
Will I be awake — and will it hurt?
Yes, you’ll be awake. We use WALANT (Wide Awake Local Anesthesia, No Tourniquet), so only your hand or wrist is numbed with local anesthetic. You may feel a brief sting as the numbing medicine goes in and some pressure during the release, but the area itself is numb. There’s no IV, no sedation, and no general anesthesia.
How long does it take, and when can I go back to work?
The release itself usually takes about 10–15 minutes, and you’re in and out of the office the same visit. Because the incision is only a few millimeters, most patients return to light daily activities and desk work within 3–5 days. Dr. Morton will give you guidance based on your job and which hand was treated.
Are there stitches or a big scar?
Usually not. The opening is tiny and is typically closed with an adhesive strip or small bandage rather than stitches, leaving minimal scarring that’s often barely visible once healed.
Is this covered by insurance or Medicare?
Ultrasound-guided carpal tunnel and trigger finger release are established medical procedures and are typically covered by most insurance plans and Medicare. Our team will verify your specific benefits before scheduling so you know what to expect.
How is this different from endoscopic or open surgery?
All of these relieve the same underlying problem. The ultrasound-guided approach uses real-time imaging to release the ligament or pulley through a few-millimeter opening — typically in the office, while you’re awake, with no operating room. This often means less scarring and a faster return to activity. Dr. Morton or Dr. Otieno will discuss whether you’re a good candidate.
Does this cost less than hospital surgery?
For many patients, yes. Because the release is performed in our office under local anesthesia, it avoids the operating-room and facility fees that come with a hospital or surgery center. Our team will verify your insurance benefits and review expected costs with you before scheduling.
Who is a good candidate?
Adults with confirmed carpal tunnel syndrome or trigger finger — especially those who haven’t gotten lasting relief from splinting, activity changes, or injections — are often good candidates. The best way to know is an in-office evaluation with ultrasound. Take the symptom survey above to see if it’s worth a visit.
Ready for relief? Let’s get you scheduled.
Book your appointment online in a couple of taps, or call us — you’ll be scheduling directly with our team, not a screening service.
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Call or text(808) 439-6201
Mon–Fri, 8:00 am – 4:30 pm HST
- Emailoffice@doctormorton.com
Book your appointment online
Choose a time that works for you with our secure Klara scheduler — for carpal tunnel, trigger finger, or a consultation.
Book Your Appointment Or call (808) 439-6201Opens our secure online scheduler. Not for medical emergencies — call 911 if you have an emergency.
Caring for hands across Hawaiʻi
Ala Moana Medical Building
1441 Kapiʻolani Blvd, Suite 2020
Honolulu, HI 96814
Kunia Shopping Center
94-673 Kupuohi St
Waipahu, HI 96797
75 Puʻuhonu Place, Suite 204
Hilo, HI 96720
Mohala Health
75-184 Hualalai Road, Suite 205
Kailua-Kona, HI 96740