J Hand Surg Am. 2026 Apr 16:S0363-5023(26)00227-3. doi: 10.1016/j.jhsa.2026.03.004. Online ahead of print.
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.
PMID:41989360 | DOI:10.1016/j.jhsa.2026.03.004