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Bethesda, MD(301) 530-1010
Dr. Marc GrunerSports & Regenerative Medicine
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Wrist & Hand Specialist

Wrist & hand specialist — carpal tunnel & trigger finger

The short answer

Dr. Gruner treats carpal tunnel syndrome and trigger finger with nerve-glide therapy, splinting, and injections — and offers minimally invasive, ultrasound-guided release procedures (Sonex carpal tunnel release and percutaneous trigger finger release) that avoid open surgery and get you back to activity in days.

Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026

Hand and wrist problems like carpal tunnel syndrome and trigger finger often come from repetitive gripping and typing. Dr. Gruner uses ultrasound to confirm the diagnosis — measuring nerve swelling or the affected tendon — and to guide precise treatment.

When conservative care isn't enough, he offers minimally invasive, ultrasound-guided release procedures: the Sonex carpal tunnel release and a percutaneous trigger finger release. Both avoid an open incision, minimize scarring, and allow a return to normal activity within days.

What is wrist and hand pain?

The wrist and hand are packed with small joints, tendons, and nerves that we rely on constantly — so pain, numbness, or loss of grip can quickly disrupt daily life and work. The most common problems Dr. Gruner sees are carpal tunnel syndrome (compression of the median nerve at the wrist) and trigger finger (a tendon that catches beneath a pulley in the finger), along with thumb and wrist arthritis and De Quervain's tenosynovitis.

Symptoms range from numbness and tingling in the fingers to catching, locking, weakness, and aching that's often worse at night or with repetitive use.

What causes carpal tunnel and trigger finger?

Both are frequently linked to repetitive gripping, typing, and forceful hand use, which irritate and swell the structures passing through tight spaces in the wrist and hand. Carpal tunnel involves the median nerve; trigger finger involves a flexor tendon catching under the A1 pulley. Certain medical conditions and pregnancy can also contribute.

How are hand conditions treated without open surgery?

Dr. Gruner starts with nerve-glide therapy, night splinting, and — when appropriate — steroid or PRP injections. For cases that need a release, he performs minimally invasive, ultrasound-guided procedures: the Sonex carpal tunnel release and a percutaneous trigger finger release. These use a tiny opening (or none at all), minimize scarring, and let most patients return to normal activities within days rather than weeks.

Wrist & Hand conditions we treat

Carpal Tunnel SyndromeMedian-nerve compression at the wrist causing hand numbness and tingling.Trigger FingerCatching or locking of a finger from tendon swelling under the A1 pulley.Wrist & Hand ArthritisCartilage wear in the small joints of the wrist and hand causing pain, stiffness, and grip weakness.De Quervain's TenosynovitisPainful irritation of the thumb-side wrist tendons, common with repetitive gripping and after pregnancy.Thumb (CMC) ArthritisArthritis at the base of the thumb causing pain with pinching, gripping, and opening jars.Gamekeeper's Thumb (UCL Injury)An injury to the thumb's inner ligament (UCL) causing pain, weakness, and instability with pinch.

Treatments and procedures for the wrist & hand

OrthobiologicsPRPConcentrated platelets from your own blood, injected under ultrasound guidance to support healing in joints and tendons.DiagnosticsMSK UltrasoundIn-office, real-time imaging of tendons, ligaments, nerves, and joints — no radiation — to pinpoint the source of pain.Office ProceduresCarpal Tunnel ReleaseA minimally invasive release of the median nerve using ultrasound guidance — back to activity in days.Office ProceduresTrigger Finger ReleaseA percutaneous, needle-based release of the A1 pulley — no incision, quick return to gripping.

Rehabilitation protocol

What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.

Ultrasound-Guided Carpal Tunnel Release — Recovery Protocol
Download full protocol (PDF)

The ultrasound-guided carpal tunnel release lets what was once major surgery be done through a tiny incision. Care is tailored to you; these guidelines help you and your therapist.

  1. Before & the day of

    Prepare

    • NSAIDs (ibuprofen/naproxen) may be used as needed for this procedure
    • Avoid alcohol 48 hours before; don't drink while on prescription pain medicine
    • Consider stopping tobacco/nicotine — it impairs healing
    • No need to fast; arrange a ride home

  2. First few days

    Protect the wrist

    • Keep the small incision clean and dry
    • Elevate the hand to reduce swelling
    • Avoid heavy gripping and lifting

  3. Return to activity

    Restore function

    • Most patients return to normal activities within 3–6 days
    • Night/tingling symptoms often improve first; numbness and strength recover over weeks

Frequently asked questions

Can carpal tunnel be fixed without open surgery?
Yes. Many cases improve with night braces, nerve-glide therapy, or injections. When a release is needed, Dr. Gruner offers an ultrasound-guided (Sonex) release with minimal scarring and a return to activities within 3–6 days.
Why is my hand numb at night?
Nighttime numbness in the thumb, index, and middle fingers is a classic sign of carpal tunnel syndrome, because wrist positions during sleep increase pressure on the median nerve. A night brace often helps, and ultrasound can confirm the diagnosis.

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