Ultrasound-guided acupotomy improves accuracy and safety in the treatment of carpal tunnel syndrome. Traditional acupotomy is minimally invasive but limited by non-visualized techniques, which can lead to inaccurate targeting and complications. Ultrasound enables real-time visualization of anatomical structures, facilitating accurate release of the transverse carpal ligament. This approach minimizes risks to neurovascular tissues. Available data show improved functional recovery and better patient experience due to greater transparency. The integration of ultrasound supports the standardization of the procedure. Further clinical studies and training protocols will help to put it into practice.