Endoscopic Carpal Tunnel Release

Techniques, Controversies, and Comparison to Open Techniques

Jacques H. Hacquebord, MD; Jeffrey S. Chen, MD; Michael E. Rettig, MD


J Am Acad Orthop Surg. 2022;30(7):292-301. 

In This Article

Abstract and Introduction


Endoscopic carpal tunnel release (ECTR) continues to rise in popularity as a treatment option for carpal tunnel syndrome. Numerous variations in technique and instrumentation currently exist, broadly classified into two-portal and single-portal techniques with antegrade and retrograde designs. ECTR is equally effective as open carpal tunnel release for alleviating symptoms of carpal tunnel syndrome with no differences in long-term outcomes. ECTR has an increased risk of transient nerve injury, whereas open carpal tunnel release has an increased risk of wound and scar complications. ECTR has higher direct costs but is associated with earlier return to work. ECTR is a safe and effective approach to carpal tunnel release in the hands of experienced surgeons.


Carpal tunnel syndrome is the most common compressive peripheral neuropathy within the United States with an incidence of 1 to 3 cases per 1,000 patients per year and a prevalence as high as 5% in the general population.[1,2] Its diagnosis carries significant disability and economic burden with approximately 500,000 carpal tunnel releases performed annually and economic cost estimates in excess of $2 billion per year within the United States alone.[3] Timely surgical intervention after failure of conservative measures may reduce economic loss and prevent permanent disability and need for reconstructive procedures.[1]

Both open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR) are popular techniques for surgical treatment of carpal tunnel syndrome. Although there currently is no consensus regarding the choice of one over the other, rates of ECTR continue to rise. Between 2005 and 2012, 14% of all carpal tunnel releases performed in the Medicare database were done endoscopically, with rates of ECTR growing by 5% annually compared with 0.9% annually for OCTR (P < 0.001).[4] Recent survey studies of the members of the American Society for Surgery of the Hand have shown as many as 26% to 36% of members using ECTR for most of their cases.[5,6] Looking at young surgeons specifically, a query of the American Board of Orthopaedic Surgery Part II database revealed an increasing proportion of carpal tunnel releases performed endoscopically, with hand fellowship-trained surgeons performing 4.5 times as many ECTRs as nonhand fellowship-trained surgeons.[7] In light of the growing popularity of ECTR, it is becoming increasingly important for surgeons to understand the technical aspects and outcomes of this technique.