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.