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


ECTR is becoming increasingly popular as an alternative technique to traditional OCTR for surgical treatment of carpal tunnel syndrome. Both are effective techniques for alleviating symptoms of carpal tunnel syndrome. ECTR is associated with accelerated recovery, quicker return of strength postoperatively, and earlier return to work, although long-term results are equivalent to OCTR. Despite numerous anatomic concerns, ECTR and OCTR have similar rates of overall complications, although ECTR has an increased risk of transient nerve injury, whereas OCTR has an increased risk of wound and scar complications. ECTR has higher direct costs than OCTR. The difference is less clear as to which procedure is more cost-effective when societal costs are factored in. Choosing between the two procedures is also potentially biased by surgeon reimbursement and salary structure due to the differences in wRVU assignments. Because ECTR is associated with a steeper learning curve, surgeons who choose to perform it should do so frequently rather than occasionally, as experience and familiarity reduce the risk of potentially devastating complications. Both OCTR and ECTR are acceptable techniques for surgical management of carpal tunnel syndrome. Regardless of choice of technique, a thorough understanding of relevant anatomy and possible variants is vital when performing carpal tunnel release.