- Type
- Keyhole (endoscopic)
- Anaesthesia
- Local + sedation, or regional block
- Day surgery
- Yes
- Dressings
- Light dressing, no plaster
- Return to desk job
- Within days
- Return to manual work
- 2–4 weeks
What it is.
Endoscopic carpal tunnel release (ECTR) is a keyhole version of the traditional open carpal tunnel release. The aim of both operations is the same — dividing the transverse carpal ligament (the roof of the carpal tunnel) to relieve pressure on the median nerve. The technique differs in how it gets there.
How it differs from the open operation.
The traditional open release uses a 2–3 cm incision down the centre of the palm. The skin, fat and palmar fascia are divided, and the transverse carpal ligament is cut under direct vision. Long-term results are excellent but the scar through the palm causes some tenderness for 6–12 weeks (pillar pain), and grip strength takes time to return.
The endoscopic release uses a 1 cm incision at the proximal wrist crease — well away from the palm. A small endoscope is introduced under the transverse carpal ligament and the underside of the ligament is visualised on a video monitor. A small retractable blade divides the ligament cleanly under direct vision. The palm itself is never cut. The result is the same divided ligament, achieved without crossing the palm.
Recovery.
Day 0–2
- Day surgery. Light dressing.
- Active finger movement immediately.
- Most patients are using the hand for light tasks within 24–48 hours.
Week 1
- Return to a desk job within days.
- Sutures absorbable; small adhesive plaster only.
Week 2–4
- Return to manual work.
- Grip strength returns to near-normal.
Month 1–6
- Numbness improves gradually as the nerve recovers.
Suitability.
Most patients with primary idiopathic carpal tunnel syndrome are candidates for endoscopic release. Open release is preferred when:
- The patient is undergoing revision carpal tunnel surgery.
- Additional procedures (e.g. trigger finger release) are being performed at the same time through the palm.
- Anatomy at the wrist precludes safe endoscopic access.
Dr Coory will discuss the choice between open and endoscopic release at your consultation.
Rehab protocol
A written, procedure-specific rehabilitation protocol is provided to your physiotherapist on the day of surgery. View the recovery roadmap for the full five-phase journey, or visit For Physiotherapists to request protocols directly.
Frequently asked questions.
How does endoscopic carpal tunnel release compare with open release?
The two techniques have equivalent long-term results in the published literature. Endoscopic release produces less scar tenderness and an earlier return to grip strength; open release remains a reliable option, particularly when other procedures are being performed at the same setting. Both have a low complication rate.
Will I need a cast?
No — just a light dressing for 24–48 hours, then a small adhesive plaster. Finger and wrist motion begins immediately.
When can I drive?
Most patients drive within a week, once the dressing is light and the hand is comfortable.
Will the numbness come straight back?
Night-time symptoms are typically gone the first night after surgery. Day-time numbness improves over weeks to months as the nerve recovers. Severe long-standing cases may have residual numbness.
Can both hands be done at once?
Bilateral release in a single operation is performed in selected patients (typically retirees with no manual work requirement). Most patients prefer to have one hand done at a time so that they can use the other hand during recovery.
References.
- Vasiliadis HS, et al. Endoscopic release for carpal tunnel syndrome. Cochrane Database Syst Rev. 2014;1:CD008265.
- Sayegh ET, Strauch RJ. Open versus endoscopic carpal tunnel release: a meta-analysis. Clin Orthop Relat Res. 2015;473(3):1120–1132.
- Atroshi I, et al. Methods of treatment for carpal tunnel syndrome. BMJ. 2009;339:b2540.