Your physician has scheduled you for an ultrasound-guided percutaneous procedure using the Spirecut technique. We would like to explain how the procedure will take place and what to expect afterward. Please note that depending on your specific situation, the organization of the clinic or practice where the procedure is performed, and your physician’s experience, there may be minor or significant differences compared to this general information. Always follow the recommendations and instructions provided by your treating physician.

The procedure you are about to undergo is percutaneous, ultrasound-guided, and performed using the Spirecut technique. What do these terms mean?

1) Percutaneous: The entire procedure is performed through a needle puncture, which heals the day after the operation. The puncture is comparable in size to that of an intravenous needle used for blood sampling. Therefore, the day after the procedure, you will no longer need a dressing, you will be able to wash your hand and resume all normal activities. There will be no sutures to remove.

2) Ultrasound-guided: The procedure is guided by ultrasound imaging (the same type of device—using a different probe—as that used during pregnancy to monitor fetal development). This allows the surgeon to clearly visualize nerves, blood vessels, and ligaments within the hand—often better than during conventional open surgery.
The Spirecut instruments, which are very fine (diameter: 1.5 mm), are introduced through the needle puncture and allow the release of the ligament compressing your nerve or tendons.

3) Spirecut: Spirecut is a Swiss company that developed the instruments enabling ultrasound-guided procedures without skin incision (other than the needle puncture), based on the invention of a Belgian surgeon, Professor Fabian Moungonodo.

It is important that you inform your physician before the procedure if you have any general health conditions, particularly if you are diabetic, taking anticoagulants, have allergies (especially to metals or local anesthetics), and/or if you are particularly anxious about medical procedures, or if you have any other medical condition that could interfere with the procedure.

Follow your physician’s instructions regarding medication intake and any required fasting. Remove nail polish, rings, and bracelets. Nails should be short and clean. Wear loose-fitting clothing.

You will be comfortably positioned, with the operated hand resting on a lateral support. The physician will first verify your positioning and perform an initial ultrasound examination to confirm that the procedure can be performed using the ultrasound-guided percutaneous technique.

Your hand will then be disinfected and placed on a sterile drape. The surgeon, now wearing sterile gloves, will cover the ultrasound probe with a sterile sheath and apply sterile gel to your hand. Local anesthesia will then be administered. Although a very fine needle is used, the injection may be slightly painful, but this will be the only uncomfortable moment of the procedure and will last no more than one minute.

The physician will then proceed with the procedure itself. It is important that you do not move your hand at all—keep it in the position chosen at the beginning of the procedure. During the release of the ligament compressing your nerve or tendons, you may feel or hear cracking sensations, but these will not be painful.

If you experience electric shock-like sensations in your fingers during the procedure, inform your physician immediately.

The procedure will conclude with the application of a dressing, which you may remove yourself 8 to 12 hours afterward. The physician may also place your arm in a sling to elevate the hand.

Postoperative pain is usually minimal at first. However, your physician may prescribe painkillers and/or anti-inflammatory medications, to be taken according to their instructions.

Eight to twelve hours after the procedure, you may remove the dressing yourself and wash your hand. Do not be surprised if your hand appears discolored—this is due to the antiseptic solution and the color may persist for about a week.

You may move your fingers and use your hand normally. However, avoid heavy activities such as lifting heavy objects or using tools requiring force.

If your physician has recommended wearing a sling, use it only when your hand is inactive—for example, while walking or watching television. The purpose is to prevent swelling, so the hand should be positioned at heart level or slightly above.

Another way to prevent swelling is the Möberg maneuver. This consists of raising the operated hand well above your head (like the Statue of Liberty position) and, every hour, fully flexing and extending all fingers ten times (including the operated finger in case of trigger finger). If performed correctly, your hand will not swell and postoperative pain will be minimal.

After trigger finger surgery, the triggering will disappear. However, it is common to experience some pain for up to two months when actively moving the operated finger. This should not be a cause for concern—these symptoms are related to the underlying tendon condition and will resolve as healing progresses.

It is also common in trigger finger pathology for finger extension not to be fully complete at the proximal interphalangeal joint (the first finger joint). This limitation may have been present before surgery and may persist or appear afterward.

Your physician will explain how to improve extension by stretching the finger into extension every hour—this may be slightly painful. In more advanced cases, a small dynamic splint may be prescribed to help straighten the finger, typically worn 6–8 hours per day, most often at night.

Before surgery, you likely experienced unpleasant tingling sensations in your fingers, at night and/or during the day. These symptoms usually resolve quickly—sometimes the day after surgery, sometimes after several weeks. If they persist beyond a few weeks, inform your physician.

In advanced cases of carpal tunnel syndrome, with finger numbness and/or weakness of the thumb muscles, recovery may take several months and is often incomplete.

To create more space for the compressed median nerve, your physician has divided the ligament compressing it, known as the transverse carpal ligament (also called the flexor retinaculum). Similar to an ankle sprain—where the ligament heals but the ankle remains swollen and painful for some time—the healing ligament can remain painful.

Pain is mainly felt at the heel of the hand and is aggravated when pressure is applied (for example, when ironing clothes). This area may also appear slightly swollen.

This pain, known as pillar pain, typically begins around ten days after surgery, peaks between four to six weeks, and then gradually resolves—often after two to three months, though it may take up to six months.

Although this pain is tolerable, it often concerns patients—particularly after percutaneous surgery where there is no visible scar. In open surgery, it is often mistakenly attributed to the skin incision.

There is no reliable way to prevent pillar pain, which affects approximately half of patients undergoing carpal tunnel surgery. However, during the first postoperative weeks, it is recommended to avoid forceful movements with the wrist bent toward the palm (palmar flexion), in order to minimize stress on the healing ligament.