Nikeeta Nancoo, Ira Bhasin, Nasir Kharma, Yousef Al Shahomi, Amar Shamsah, Ezzeldin A Shalaby, Amanda Jane Abel, Aaron Samuel, Helal Salem Alhajri, Najeeb Ansari, Bramaes Dahal, Manju Rai
Long-term outcomes of CTS surgery are broadly equivalent across techniques when adequate decompression is achieved. The surgical approach should be individualized based on disease severity, patient factors, occupational demands, and surgeon expertise. Further high-quality, long-term comparative studies are needed to define the role of emerging ultra-minimally invasive techniques.
PURPOSE: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with surgical decompression as the definitive treatment for refractory or severe cases. With the evolution of surgical techniques, from open carpal tunnel release (OCTR) to endoscopic (ECTR) and ultra-minimally invasive ultrasound-guided approaches, there remains a need for a comprehensive comparative evaluation. This review aims to critically assess contemporary surgical modalities for CTS and to provide an evidence-based framework for patient-centered surgical decision-making.
METHODS: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Cochrane Library, and Web of Science, covering studies from 1985 to February 2026. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses reporting clinical outcomes of OCTR, ECTR, and ultrasound-guided techniques. Outcomes assessed included symptom relief, functional scores, complications, recurrence, return to work, and cost-effectiveness. Data were synthesized thematically due to heterogeneity.
RESULTS: OCTR and ECTR demonstrate comparable long-term symptom relief and functional outcomes. ECTR offers advantages in early postoperative recovery, including reduced pain and faster return to work. Ultra-minimally invasive ultrasound-guided techniques show promising early outcomes and accelerated recovery in selected patients, though long-term data remain limited. Complication rates are low across techniques and are influenced more by surgical expertise and completeness of release than by approach alone. Economic analyses suggest early recovery may offset higher procedural costs in working populations.
CONCLUSION: Long-term outcomes of CTS surgery are broadly equivalent across techniques when adequate decompression is achieved. The surgical approach should be individualized based on disease severity, patient factors, occupational demands, and surgeon expertise. Further high-quality, long-term comparative studies are needed to define the role of emerging ultra-minimally invasive techniques.