The CLEAR procedure: A five-step safety framework for ultrasound-guided carpal tunnel release

Ultrasound-guided carpal tunnel release (CTR-US) has emerged as a reliable and minimally invasive alternative to open or endoscopic surgery. However, the variability of techniques and the absence of a standardized framework may increase the risk of iatrogenic complications, particularly during the learning curve.

To describe the CLEAR procedure, a five-step structured method designed to ensure safety, reproducibility, and educational consistency in ultrasound-guided median nerve release at the carpal tunnel.

The CLEAR procedure synthesizes current anatomical, technical, and interventional imaging data into five core principles: C - Critical anatomical awareness, building a precise mental map of the carpal tunnel anatomy before starting. L - Locate with ultrasound, to define a patient-specific safe zone. E - Equip with the appropriate device, selecting a blade that provides constant visualization and reproducible mechanics. A - Always visualize the blade, ensuring continuous ultrasound control during ligament section. R - Rule out bleeding, with final Doppler verification performed without a tourniquet.

This codified sequence standardizes the operative workflow, reducing operator-dependent variability. Continuous ultrasound visualization and final Doppler control significantly minimize iatrogenic events and postoperative hematomas.

The CLEAR procedure provides a pragmatic, safety-oriented pedagogical framework for CTR-US. It articulates the principle that no step is complete until safety has been verified. Prospective evaluation of CLEAR versus usual care is warranted.