About the Guest
Bob Paulson is the President and CEO of Sonex Health, a company pioneering ultrasound-guided procedures to treat carpal tunnel and trigger finger syndromes. Future ultrasound-guided applications will include the treatment of other upper extremity entrapment neuropathies. Bob has led multiple venture-backed medical device companies through commercialization, including NxThera, acquired by Boston Scientific, Restore Medical, acquired by Medtronic, and VentureMed Group. Earlier in his career, Bob held senior leadership roles at Medtronic, Advanced Bionics, and Endocardial Solutions, acquired by St. Jude Medical.
Interview Summary
Founded by two Mayo Clinic physicians, Sonex developed UltraGuideCTR, a minimally invasive device that allows physicians to move carpal tunnel release procedures from the operating room to in-office procedure rooms using real-time ultrasound guidance and local anesthesia, which both expands patient access and reduces the cost of care.
Carpal tunnel syndrome is one of the most common nerve compression disorders, yet more than 80% of patients who need intervention to relieve that compression opt out of a surgical carpal tunnel release procedure because of the recovery times that can be weeks or months before patients can return to normal activities and work. The Sonex Health technology addresses this unmet need by allowing the physician to release the nerve compression with a minimally invasive ultrasound-guided approach using only local anesthesia with a very small (4-6 mm) incision in the wrist that is closed with a Steri-Strip (no sutures required), allowing patients to return to daily activities and work within days. Since the first commercial ultrasound-guided carpal tunnel release procedures in 2018, the company has treated more than 55,000 patients.
Beginning in 2022, Sonex began building a clinical evidence portfolio to support FDA clearance, a new Category I CPT code, and payer coverage, which now includes 21 peer-reviewed publications reporting outcomes data on more than 2,300 patients and 2,800 hands. The published clinical data portfolio includes the largest comparative carpal tunnel release study conducted in the United States, reporting outcomes data on more than 1,400 patients. Sonex has also made significant investments in physician education and training, practice development, and additional clinical studies examining the effect on disparate patient populations and health economics.
Following the January 2026 effective of a new Category I CPT code for ultrasound-guided carpal tunnel release procedures, Sonex expanded its commercial footprint to accelerate the expansion of physician adoption and utilization nationwide.
Top Takeaways
If your technology requires a new reimbursement pathway, FDA clearance is only the first hurdle. Map the evidence needed for FDA, CPT coding, and payer coverage before your first clinical study begins, and design trials that satisfy all three wherever possible. Build a clinical evidence roadmap that answers each stakeholder's questions — from comparative effectiveness to health economics and appropriate use criteria. That approach influences study design, capital requirements, commercialization timelines, and ultimately how quickly physicians will adopt the therapy.
Therapies that change physician workflow demand a different commercialization strategy. In these cases, clinical evidence alone won't change how physicians practice. Driving adoption becomes an exercise in practice development — educating physicians and staff, ensuring predictable coverage and payment, supporting providers as they transition to new workflows, and tailoring the commercial approach to match economic incentives.
Build your capital strategy by working backwards from your value inflection points. Understand whether you're building a tuck-in or a fully commercial company, then determine the capital required to reach each value inflection point. Choose investors who can finance that journey by evaluating their fund size, follow-on capacity, and speaking with CEOs they've previously backed. If one investor can't support the path ahead, build the syndicate early.
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