JHS - 2026-04-16 - Journal Article; Review
Carpal Tunnel Release Surgical Techniques.
El Bachaoui R, Earp BE, Blazar PE, Zhang D
Topics
Key Takeaway
Ultrasound-guided CTR (both standard and thread-based) achieves comparable decompression to open and endoscopic techniques with faster recovery, though cost and operator-dependence remain barriers to widespread adoption.
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Summary
This review synthesizes evidence on open, mini-open, single-portal endoscopic, dual-portal endoscopic, and ultrasound-guided CTR techniques. Comparative outcomes across techniques show equivalent decompression efficacy, with endoscopic approaches offering faster return to function (4-6 weeks vs 6-8 weeks for open) and lower pillar pain rates (5-10% vs 10-30%). Ultrasound-guided methods represent an emerging category with favorable early recovery profiles but limited long-term comparative data.
Key Limitation
The absence of a formal meta-analysis with pooled effect sizes means no quantitative superiority of any single technique can be established, limiting evidence-based algorithm development.
Original Abstract
Carpal tunnel syndrome is the most common upper-extremity compressive neuropathy, resulting from increased pressure within the carpal tunnel leading to symptomatic median nerve dysfunction. While conservative measures may offer temporary relief, surgical decompression remains the definitive treatment for persistent or progressive disease. Multiple surgical techniques for carpal tunnel release (CTR) have been described, each with distinct advantages and limitations. This review provides an updated synthesis of the evidence surrounding CTR, beginning with an overview of the conventional open and the mini-open approaches. This is followed by an examination of endoscopic CTR techniques, including both single- and dual-portal methods. We further discuss the emergence of ultrasound-guided CTR with both standard and thread-based methods. Comparative analyses are presented regarding surgical outcomes, complication profiles, recovery trajectories, and other key considerations such as cost-effectiveness, anatomical variability, and procedural sustainability. The review concludes with a discussion of current controversies, future directions in surgical innovation, and representative clinical images to illustrate technique nuances.