Lacertus syndrome is a condition characterized by the compression of the median nerve around the elbow. It has long since been recognized as the pronator syndrome. We describe our microinvasive ultrasound-guided release of the lacertus fibrosus (LF) superficial to the belly of the pronator teres. The procedure is performed under wide-awake local anesthesia with no tourniquet (WALANT) anesthesia. We have performed more than 700 patients percutaneously under ultrasound. No perioperative complication occurred, including injury to any notable structure. The technique yields high success rates appearing similar to those reported with more invasive surgical interventions. With real-time monitoring of major nerves and vessels, ultrasound guidance secures the procedure.