A Comparative Study of Endoscopic Carpal Tunnel Release and Open Carpal Tunnel Release for Carpal Tunnel Syndrome

A Comparative Study of Endoscopic Carpal Tunnel Release and Open Carpal Tunnel Release for Carpal Tunnel Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comparative Study of Endoscopic Carpal Tunnel Release and Open Carpal Tunnel Release for Carpal Tunnel Syndrome Zhiqi Zhang, Yulong Liu, Huarui Yang, Bihui Song, Kangquan Shou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9123689/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose To compare the efficacy of endoscopic carpal tunnel release and open carpal tunnel release in the treatment of carpal tunnel syndrome. Methods A retrospective analysis was performed on clinical data of 112 patients with carpal tunnel syndrome admitted from January 2022 to December 2024. The BCTQ-SSS, BCTQ-FSS, pain VAS, median nerve electrophysiological indices (SNCV, SNAP amplitude, DML, CMAP amplitude), and complications were assessed and documented. Results According to the predefined inclusion and exclusion criteria, 82 of 112 patients were included, with a median follow-up of 34 months (range 13–48 months). 35 patients underwent ECTR and 47 underwent OCTR. At the final follow-up, both groups achieved significant improvements in VAS score, BCTQ-SSS, BCTQ-FSS, and all electrophysiological parameters (SNCV, SNAP, DML, CMAP) versus preoperative baseline. No significant intergroup differences were found in these postoperative outcomes (all P > 0.05). The ECTR group had significantly shorter operative time and lower hospitalization cost than the OCTR group (both P < 0.001). Conclusion This single-center retrospective study with short-term follow-up has inherent limitations, yet our results confirm favorable clinical efficacy for both surgical approaches. Endoscopic carpal tunnel release provides minimal invasiveness and less scarring, whereas open release features shorter operation time and lower inpatient costs. Level of evidence Level IV retrospective case series. carpal tunnel syndrome endoscope neurolysis neuroelectrophysiology Figures Figure 1 Introduction Carpal tunnel syndrome (CTS) is the most prevalent upper extremity peripheral nerve entrapment neuropathy worldwide, with a prevalence of 3.8% in the general population. In the United States alone, over 600,000 patients undergo carpal tunnel release (CTR) annually, imposing a substantial burden on healthcare systems and societal workforce productivity[ 1 – 3 ]. As the leading cause of hand dysfunction secondary to nerve entrapment, the standardized surgical management of CTS has long been a key research focus and clinical hotspot in the field of hand surgery. The core pathological change of CTS is compression of the median nerve within the carpal tunnel, which can lead to progressive pain, paresthesia, and motor dysfunction of the hand, severely impairing patients’ quality of life and work capacity[ 4 ]. For patients with moderate-to-severe CTS who show no response to conservative management, surgical division of the transverse carpal ligament (TCL) to achieve median nerve decompression is currently a well-recognized definitive treatment strategy[ 5 ]. Conventional open carpal tunnel release (OCTR) has long been regarded as the gold standard procedure for CTR, with the advantages of adequate surgical field exposure, a low technical threshold, and broad clinical indications[ 6 , 7 ]. As a minimally invasive alternative, endoscopic carpal tunnel release (ECTR) has seen a continuous rise in clinical adoption since its introduction. Its core benefits include minimal soft tissue trauma and a more cosmetically favorable postoperative scar, theoretically enabling a more rapid postoperative recovery[ 4 , 8 – 10 ]. Previous comparative studies and systematic reviews evaluating these two surgical approaches have yielded inconsistent conclusions[ 11 ]. In a randomized controlled trial, MacDermid et al.[ 8 ] found that ECTR conferred a short-term advantage in grip strength recovery and pain relief at 1 and 6 weeks postoperatively, but this difference was completely abolished by 12 weeks after surgery. The latest meta-analysis by Boutros et al.[ 6 ], which enrolled 44 comparative studies, revealed no statistically significant differences between the two techniques in terms of long-term pain relief, functional recovery, muscle strength improvement, and overall complication rates, while the ECTR group had a significantly lower postoperative revision rate. To further clarify the clinical application value of different CTR surgical techniques, we conducted a single-center retrospective study. We collected the clinical data and follow-up information of patients with CTS who underwent surgical treatment at our institution, and performed a comparative analysis of the clinical efficacy, complications, and prognostic outcomes between OCTR and ECTR. This study aims to provide real-world data to support clinical decision-making in the selection of surgical approaches for CTS. 1. Methods & methods This study was approved by the Ethics Committee of Yichang Central People’s Hospital and performed in accordance with the Declaration of Helsinki (2026-021-01). 1.1 Inclusion and exclusion criteria The inclusion criteria for this study are as follows: (1) a clinical diagnosis of CTS based on symptoms and physical examination findings; (2) electrophysiological findings consistent with the diagnostic criteria for CTS, characterized by prolonged motor latency, reduced amplitude of the median nerve at the wrist, prolonged sensory latency, reduced amplitude, slowed conduction velocity, and, in severe cases, absence of both motor and sensory potentials[ 12 ];(3) Failure of a 2-month conservative treatment regimen; (4) Patients with unilateral disease; (5) Follow-up period exceeding 6 months, with a comprehensive dataset. The exclusion criteria were as follows: (1) Patients with CTS who did not undergo surgical treatment in accordance with the study protocol;(2) Patients with a mass within the carpal tunnel detected via ultrasonographic examination;(3) Patients with bony or articular abnormalities of the carpal tunnel indicated by plain radiography;(4) Patients with a concurrent diagnosis of osteoarthritis, rheumatoid arthritis, or gouty arthritis involving the wrist joint;(5) Patients with a follow-up period of less than 6 months or incomplete clinical datasets. 1.2 Clinical data Between January 2022 and December 2024, a total of 112 patients were diagnosed with CTS. Of these, 82 patients who met the aforementioned inclusion criteria were enrolled in this study (Fig. 1 ). A comprehensive retrospective review was performed on the clinical data and electrophysiological characteristics of the enrolled patients. Baseline clinical data included age, sex, and body mass index (BMI). The outcome measures included the symptom severity score (SSS) and functional status score (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ), the Visual Analogue Scale (VAS), as well as electrophysiological parameters of the median nerve: sensory nerve conduction velocity (SNCV), sensory nerve action potential (SNAP) amplitude, distal motor latency (DML), and compound muscle action potential (CMAP) amplitude. Long-term complications and reoperation rates were recorded. All questionnaires were completed independently by each patient. 1.3 Boston Carpal Tunnel Questionnaire The Boston Carpal Tunnel Questionnaire (BCTQ) was developed by David W. Levine from Brigham and Women’s Hospital in Boston, USA, in 1993. It consists of two core domains: the Symptom Severity Score (SSS) and the Functional Status Score (FSS). The SSS evaluates the frequency and severity of core CTS symptoms, while the FSS assesses the impact of CTS on patients’ ability to perform activities of daily living (ADLs). The clinically recognized thresholds for the Patient Acceptable Symptom State (PASS) are an SSS ≤ 1.82 and an FSS ≤ 1.50; scores below these thresholds indicate that the patient has achieved clinically satisfactory recovery of symptoms and functional status[ 13 , 14 ]. 1.4 Neuroelectrophysiology examination The summary of the 2024 Clinical Practice Guideline for CTS issued by the American Academy of Orthopaedic Surgeons (AAOS) has repeatedly highlighted neuroelectrophysiological assessment and identified it as a core reference modality for CTS diagnosis[ 15 ]. SNCV, SNAP, DML, and CMAP of the median nerve play a critical role in the diagnosis, severity stratification, and prognostic assessment of CTS[ 16 ]. 1.5 Statistical analysis Statistical analyses were performed using SPSS version 25.0 software (SPSS Inc., Chicago, IL, USA). Categorical variables were presented as frequencies and percentages, and intergroup comparisons were conducted using the chi-square test. Continuous variables were expressed as mean ± standard deviation (SD). The Shapiro-Wilk test was used to verify the normality of data distribution, and Levene’s test was applied to assess the homogeneity of variances between groups. For intergroup comparisons of continuous variables, the independent samples t-test was used when data were normally distributed with homogeneous variances, while Welch’s corrected t-test was adopted in cases of heterogeneous variances. The Mann-Whitney U test was performed for data with a non-normal distribution. A P -value < 0.05 was considered to indicate a statistically significant difference. 2. Surgical Procedure OCTR was performed using the mini-palm open release technique, which was first described by G.S. Bromley[ 17 ]. ECTR was conducted with a specialized technique using a transparent, colorless plastic protective sheath fabricated from a syringe, which was first reported by Bo Liu[ 18 ]. 3. Results Between January 2022 and December 2024, a total of 112 patients were diagnosed with CTS. Of these, 82 patients (55 females and 27 males) met the inclusion criteria and were enrolled in this study. The median follow-up duration of all patients was 34 months (range, 13–48 months), and no vascular or neurological complications occurred in any patient during the follow-up period. Among the enrolled patients, 47 cases underwent OCTR, and the remaining 35 cases received ECTR. We first compared the preoperative baseline characteristics between the two groups of patients. There were no statistically significant differences in age, sex distribution, and body mass index (BMI) between the two groups (all P > 0.05), indicating that the demographic characteristics of the two groups were comparable (Table 1 ). No statistically significant differences were observed in the preoperative VAS score, BCTQ-SSS, and BCTQ-FSS between the OCTR group and the ECTR group (all P > 0.05). For the preoperative neuroelectrophysiological parameters, including SNCV, SNAP amplitude, DML, and CMAP amplitude, no significant differences were detected between the two groups (all P > 0.05, Table 2 ). These results confirmed that the baseline characteristics of the two groups were well-balanced and comparable. Table 1 Patient demographics characteristics. Variables Open(n = 47) Endoscopic(n = 35) P Value Age (years) 53.33 ± 8.66 53.42 ± 9.67 0.9647 Sex (M/F) 15(31.91)/32(68.08%) 12(35.29%)/23(65.71%) 0.8212 BMI (kg/m 2 ) 24.38 ± 3.12 24.29 ± 2.77 0.8926 Left/Right 19(40.43%)/28(59.57%) 13(37.14%)/22(62.86%) 0.7633 BMI , body mass index; At the final follow-up, both groups achieved remarkable improvements in clinical symptom scores and nerve electrophysiological indicators relative to their preoperative baseline levels. In the intergroup comparison, no statistically significant differences were found in the VAS scores (0.38 ± 0.49 vs 0.34 ± 0.48, P = 0.7132), BCTQ-SSS scores (12.38 ± 1.13 vs 12.51 ± 1.15, P = 0.6103), and BCTQ-FSS scores (9.43 ± 1.85 vs 9.49 ± 1.29, P = 0.8630) between the OCTR and ECTR groups. Consistently, the final follow-up nerve electrophysiological outcomes, including SNCV (46.51 ± 2.57 m/s vs 45.71 ± 3.22 m/s, P = 0.2146), SNAP (15.30 ± 3.51 µV vs 16.40 ± 2.79 µV, P = 0.1304), DML (4.77 ± 0.44 ms vs 4.68 ± 0.42 ms, P = 0.3530), and CMAP (12.23 ± 1.31 mV vs 12.51 ± 1.12 mV, P = 0.3121), showed no significant differences between the two groups (all P > 0.05, Table 2 ). Table 2 Preoperative and postoperative VAS scores, BCTQ scores, and nerve electrophysiological examination outcomes of patients Variables Prior to surgery Final follow-up Open (n = 47) Endoscopic (n = 35) P value Open (n = 47) Endoscopic (n = 35) P value VAS 2.77 ± 0.91 2.66 ± 0.97 0.5999 0.38 ± 0.49 0.34 ± 0.48 0.7132 BCTQ-SSS 22.06 ± 5.91 21.77 ± 5.59 0.8224 12.38 ± 1.13 12.51 ± 1.15 0.6103 BCTQ-FSS 12.30 ± 3.54 12.63 + 2.10 0.5998 9.43 ± 1.85 9.49 ± 1.29 0.8630 SNCV (m/s) 38.77 ± 3.82 39.57 ± 3.23 0.3202 46.51 ± 2.57 45.71 ± 3.22 0.2146 SNAP (𝜇V) 12.38 ± 1.81 12.31 ± 1.64 0.8575 15.30 ± 3.51 16.40 ± 2.79 0.1304 DML (ms) 5.02 ± 0.33 5.14 ± 0.35 0.1163 4.77 ± 0.44 4.68 ± 0.42 0.3530 CMAP (mV) 9.43 ± 1.21 9.51 ± 1.18 0.7656 12.23 ± 1.31 12.51 ± 1.12 0.3121 BCTQ-SSS: the symptom severity scale of Boston carpal tunnel questionnaire; BCTQ-FSS: the functional status scale of Boston carpal tunnel questionnaire; CMAP: compound muscle action potential; DML: distal motor latency; SNAP: sensory nerve action potential; SNCV: sensory nerve conduction velocity. The perioperative outcomes of the two groups are summarized in Table 3 . The mean operative time was significantly longer in the ECTR group than in the OCTR group (46.91 ± 6.22 min vs 35.11 ± 4.40 min, P < 0.001). In addition, the total hospitalization cost of the ECTR group was significantly higher than that of the OCTR group (8059.85 Yuan vs 6995.57 Yuan, P < 0.001). Table 3 Perioperative Outcomes of the Two Groups. Variables Open(n = 47) Endoscopic(n = 35) P Value Surgery time (min) 35.11 ± 4.40 46.91 ± 6.22 P < 0.001 Costs (Yuan) 6995.57 (5898.34, 7436.60) 8059.85 (6715.24, 8739.40) P < 0.001 4. Discussion In this single-center retrospective analysis enrolling 82 patients with CTS, we compared the clinical efficacy, perioperative parameters, and long-term follow-up outcomes between ECTR and OCTR. The core finding was that there were no statistically significant differences between the two surgical approaches in terms of postoperative pain relief, functional recovery, and neuroelectrophysiological improvement, whereas OCTR exhibited significant advantages of shorter operative time and lower hospitalization costs. These findings not only fulfill the study objective of clarifying the clinical application value of the two CTR modalities stated in the Introduction but also provide real-world evidence-based support for clinical surgical decision-making in CTS. Meanwhile, the clinical implications and scientific value of these results warrant in-depth interpretation in the context of the existing research landscape and the inherent limitations of the present study. CTR serves as the first-line definitive treatment for moderate to severe CTS following failure of conservative treatment, and the optimization of its surgical modalities has long been a key research focus in the field of hand surgery[ 19 ]. The results of this study demonstrated that postoperative VAS scores, BCTQ-SSS and BCTQ-FSS scores, as well as median nerve electrophysiological parameters (including SNCV, SNAP amplitude, DML, and CMAP amplitude) were all significantly improved relative to the preoperative baseline in both groups, with no statistically significant differences detected between the two groups. This finding is consistent with the conclusions of the meta-analysis published by Masri et al.[ 20 ], which confirmed no significant differences between the two surgical modalities in long-term pain relief, functional recovery, and the incidence of complications. Collectively, these data further verify the robust clinical efficacy of both CTR procedures. The randomized controlled trial (RCT) conducted by Joy C et al.[ 8 ] also demonstrated that although ECTR had short-term advantages in grip strength recovery and pain relief at 1 to 6 weeks postoperatively, this difference completely disappeared by 12 weeks after surgery. This finding aligns well with the long-term follow-up results (median follow-up duration of 34 months) of the present study, indicating consistent long-term efficacy between the two surgical modalities. Furthermore, neuroelectrophysiological parameters are recognized as the core benchmarks for evaluating postoperative recovery in CTS. Significant improvements in these parameters directly reflect the efficacy of median nerve decompression [ 21 ], which provides a solid theoretical foundation for the efficacy assessment framework employed in the present study. About perioperative parameters, the present study revealed that OCTR was associated with a significantly shorter operative time (35.11 ± 4.40 min vs. 46.91 ± 6.22 min, P < 0.001) and significantly lower hospitalization costs (6995.57 Yuan vs. 8059.85 Yuan, P < 0.001) compared with ECTR. This finding aligns with the conclusions of a portion of prior studies, while conflicting with those reported in other published investigations. Studies by Teng et al.[ 22 ] and Zheng et al.[ 23 ] reported that endoscopic carpal tunnel release had a shorter operative time compared with open surgery. Such discrepancies in study findings may be attributed to variations in surgical modality selection, surgeon operative proficiency, and the severity of patients’ CTS. Notably, in the present study, the ECTR procedure was performed using a novel endoscopic technique, which required preparation of a transparent, colorless plastic protective sheath fabricated from a standard syringe. In contrast, the modified mini-palm open release technique adopted for OCTR provided adequate surgical field exposure and a simplified operative workflow, thus resulting in a shorter operative duration. A 2024 study by Thomas et al.[ 24 ] also reported that conventional ECTR generally required a longer operative time than conventional open surgery, as it necessitated the establishment of an endoscopic working channel and precise anatomical localization of carpal tunnel structures. Meanwhile, the utilization of endoscopic equipment was associated with increased hospitalization costs, which is consistent with the finding of higher hospitalization costs for ECTR in the present study. From a pathophysiological perspective, both surgical procedures effectively improve clinical symptoms and neuroelectrophysiological parameters in patients with CTS. The core mechanism underlying these improvements is the release of the transverse carpal ligament (TCL), which relieves mechanical compression on the median nerve and restores its blood supply and conduction function[ 4 ]. The 2025 updated Clinical Practice Guideline for CTS issued by the AAOS[ 15 ] explicitly states that median nerve SNCV, SNAP, DML, and CMAP are core parameters for evaluating the severity of CTS and postoperative recovery, and the degree of their improvement directly reflects the efficacy of median nerve decompression. Preclinical animal studies have demonstrated that release of the TCL can significantly reduce median nerve thickness, improve nerve conduction function, and downregulate the levels of inflammatory cytokines within the carpal tunnel, which constitutes the key pathophysiological basis underlying the clinical efficacy of both surgical procedures[ 25 ]. In the present study, significant elevations in SNCV, SNAP amplitude and CMAP amplitude, alongside significant shortening of DML, were observed postoperatively in both patient groups. These findings indicate that both surgical modalities can effectively achieve adequate decompression of the median nerve, which is consistent with the conclusions of the 2024 CTS review by Alrayes et al.[ 26 ]. The review confirmed that complete release of the TCL, whether performed via an open or endoscopic surgical approach, can effectively restore median nerve function. Furthermore, the study on the application of the BCTQ scale in Chinese populations conducted by Lue et al.[ 27 ] found that the Chinese version of the BCTQ is a reliable and valid instrument for evaluating symptom severity and functional status in patients with CTS. In the present study, the significant postoperative improvement in BCTQ scores in both groups further verified the efficacy of the two surgical modalities in alleviating symptoms and restoring hand function, which is fully consistent with the conclusions of the study. The clinical value of the present study mainly lies in providing precise evidence-based reference for surgical decision-making of CTS in real-world clinical settings. As the most prevalent upper extremity peripheral nerve entrapment disorder worldwide, CTS has a prevalence rate of 9.6% among office workers in China, has been included in China’s statutory list of occupational diseases, and a large number of patients undergo CTR annually[ 28 ]. Selecting a more cost-effective and efficient surgical modality while ensuring consistent therapeutic efficacy is of great clinical and socioeconomic significance for alleviating the healthcare burden and improving patients’ healthcare experience. The present study demonstrated that OCTR and ECTR achieved comparable clinical efficacy, whereas OCTR exhibited distinct advantages in operative time and medical costs, making it particularly suitable for primary healthcare institutions and cost-sensitive patients. As a minimally invasive surgical modality, ECTR offers the benefits of minimal surgical trauma and inconspicuous postoperative scarring, and can be prioritized for younger patients with high cosmetic demands. These findings are consistent with the results reported by Rajapandian et al.[ 29 ], which stated that the cosmetic advantage of ECTR represents a core value for its clinical application, while the high efficiency and cost-effectiveness of OCTR are more favorable for large-scale clinical implementation. Several limitations of the present study should be objectively acknowledged. First, this study was a single-center retrospective analysis with a limited enrolled sample size of 82 patients. Furthermore, only patients with unilateral CTS were included, which inevitably restricts the generalizability of the findings. The results cannot be extrapolated to complex clinical scenarios, including patients with bilateral CTS or those complicated with other joint disorders. Second, the median follow-up duration of this study was 34 months. Although this meets the standard for medium-to-long-term follow-up, it remains insufficient to evaluate the long-term efficacy and complication risk of the two surgical modalities beyond 5 years postoperatively. Previous studies have indicated that a minimum follow-up period of 5 years is required for patients after CTS surgery to assess the long-term stability of median nerve function and the risk of reoperation[ 30 ]. Furthermore, no standardized and unified postoperative rehabilitation protocol was implemented for the enrolled patients in the present study, while rehabilitation interventions have a well-recognized critical impact on postoperative functional recovery after CTS surgery[ 31 ]. This may act as a potential confounding factor influencing the differences in functional recovery between the two groups. Finally, no blinded assessment of outcome measures was performed in the present study, which may introduce subjective bias; this is a well-recognized common limitation inherent to retrospective study designs. Multicenter, large-sample, prospective randomized controlled trials (RCTs) are warranted in the future to further validate the findings and conclusions of the present study. 5. Conclusion This study confirms that both ECTR and OCTR yield good mid-term outcomes in the treatment of CTS, and there is no significant difference in efficacy between the two procedures. However, OCTR offers the advantages of shorter operative time and lower hospitalization costs, while ECTR is characterized by minimal trauma and a cosmetically pleasing postoperative scar. In clinical practice, the choice of surgical approach can be tailored to the patient’s specific needs, the technical capabilities of the medical institution, and the surgeon’s experience. Declarations Conflicts of interest The authors declare that they have no conflicts of interest. Consent for publication Written informed consent for publication was obtained from all participants. Informed consent Informed consent was obtained from all individual participants included in the study. Ethics approval This study was approved by the Ethics Committee of Yichang Central People's Hospital and performed in accordance with the Declaration of Helsinki (2026-021-01). Funding There is no funding source. Author Contribution ZZ: Manuscript writing and data collection， YL: Data collection, HY: Performer of surgery, SB and KS: Supervision of the research process and revision of the manuscript. Data Availability The datasets used during the current study are available from the corresponding author upon reasonable request. References Pripotnev S, Mackinnon SE. Revision of Carpal Tunnel Surgery. J Clin Med 2022, 11(5). Latzka EW, Henning PT, Pourcho AM. Sonographic Changes After Ultrasound-Guided Release of the Transverse Carpal Ligament: A Case Report. Pm r. 2018;10(10):1125–9. Cognet JM, Apard T, Garret J, Martinel V, Mares O. Ultrasound-guided carpal tunnel release: Anatomical landmarks, surgical technique, and literature review. Hand Surg Rehabil. 2025;44(5):102201. Xu Y, Deng S, Xu L, Li S, Ji Z. The application of ultrasound-guided percutaneous transforaminal endoscopy in treating carpal tunnel syndrome. J Orthop Surg Res. 2025;20(1):747. Bland JD. Treatment of carpal tunnel syndrome. 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Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health. 2021;21(1):57. Rajapandian R, Moti Wala S, Aledani EM, Samuel EA, Ahmad K, Manongi NJ, Rauf Butt S. Endoscopic Versus Open Carpal Tunnel Release: A Systematic Review of Outcomes and Complications. Cureus. 2024;16(7):e64991. Kahan R, Garoosi K, Enthoven LF, Gehring M, Greyson M. Reoperation Rates and Short-Term Complications Following Endoscopic vs. Open Carpal Tunnel Release: A Longitudinal Analysis. Hand (N Y) 2025:15589447251333817. Newington L, Madan I, Sandford F. Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study. Hand Ther. 2022;27(3):71–82. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9123689","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608594478,"identity":"66988ebe-04f3-449f-a002-be45ed0402b4","order_by":0,"name":"Zhiqi Zhang","email":"","orcid":"","institution":"Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhiqi","middleName":"","lastName":"Zhang","suffix":""},{"id":608594479,"identity":"d0d2e7a5-d124-40be-b276-09869a73b898","order_by":1,"name":"Yulong Liu","email":"","orcid":"","institution":"Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yulong","middleName":"","lastName":"Liu","suffix":""},{"id":608594480,"identity":"5cfc2537-1b00-430e-a2e9-3bce5ec6d8a4","order_by":2,"name":"Huarui Yang","email":"","orcid":"","institution":"Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huarui","middleName":"","lastName":"Yang","suffix":""},{"id":608594481,"identity":"d06a80b2-b357-4649-9b08-2438e89b17c1","order_by":3,"name":"Bihui Song","email":"","orcid":"","institution":"Yichang Central People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bihui","middleName":"","lastName":"Song","suffix":""},{"id":608594482,"identity":"f5465e49-c4a7-4177-adad-368cdada469c","order_by":4,"name":"Kangquan Shou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACxmYInQBiPwASMgwMbMRrYTZgYDDgIagFBkBa2CSI0sLczp26mXePTR6/9NljFR/b/vDws7clMPyo2IbHYbzbbvM8SyuW7MtLuzmzzYBHsufYAcaeM7cJaDlwOHHDGR6z27xALQY30huYGdsIavkP1lJMipYDYC3MEC1pBwhquTnnQHKxZA+PseSMc8YgvyQcxOcXw/6z2268OWCXx8/DY/jhQ5mcHDDEDB/8qMCjpYGBgYkHXfQATvVAIA9y3A98KkbBKBgFo2AUAADQVlUzaciRuwAAAABJRU5ErkJggg==","orcid":"","institution":"Yichang Central People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kangquan","middleName":"","lastName":"Shou","suffix":""}],"badges":[],"createdAt":"2026-03-14 15:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9123689/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9123689/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105057660,"identity":"9b7f5ac4-eeb3-40e9-b4cc-2d85cc1fb693","added_by":"auto","created_at":"2026-03-20 12:06:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66551,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart showing patient cohort inclusion\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9123689/v1/15134dd839615e9adff58b7e.png"},{"id":105870372,"identity":"ee546830-9309-4de7-9672-8368a83bcb89","added_by":"auto","created_at":"2026-04-01 04:25:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":670133,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9123689/v1/2e1c1621-1920-4d86-af1f-f9a6d65b3396.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Comparative Study of Endoscopic Carpal Tunnel Release and Open Carpal Tunnel Release for Carpal Tunnel Syndrome","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCarpal tunnel syndrome (CTS) is the most prevalent upper extremity peripheral nerve entrapment neuropathy worldwide, with a prevalence of 3.8% in the general population. In the United States alone, over 600,000 patients undergo carpal tunnel release (CTR) annually, imposing a substantial burden on healthcare systems and societal workforce productivity[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As the leading cause of hand dysfunction secondary to nerve entrapment, the standardized surgical management of CTS has long been a key research focus and clinical hotspot in the field of hand surgery.\u003c/p\u003e \u003cp\u003eThe core pathological change of CTS is compression of the median nerve within the carpal tunnel, which can lead to progressive pain, paresthesia, and motor dysfunction of the hand, severely impairing patients\u0026rsquo; quality of life and work capacity[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For patients with moderate-to-severe CTS who show no response to conservative management, surgical division of the transverse carpal ligament (TCL) to achieve median nerve decompression is currently a well-recognized definitive treatment strategy[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Conventional open carpal tunnel release (OCTR) has long been regarded as the gold standard procedure for CTR, with the advantages of adequate surgical field exposure, a low technical threshold, and broad clinical indications[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As a minimally invasive alternative, endoscopic carpal tunnel release (ECTR) has seen a continuous rise in clinical adoption since its introduction. Its core benefits include minimal soft tissue trauma and a more cosmetically favorable postoperative scar, theoretically enabling a more rapid postoperative recovery[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious comparative studies and systematic reviews evaluating these two surgical approaches have yielded inconsistent conclusions[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In a randomized controlled trial, MacDermid et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] found that ECTR conferred a short-term advantage in grip strength recovery and pain relief at 1 and 6 weeks postoperatively, but this difference was completely abolished by 12 weeks after surgery. The latest meta-analysis by Boutros et al.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which enrolled 44 comparative studies, revealed no statistically significant differences between the two techniques in terms of long-term pain relief, functional recovery, muscle strength improvement, and overall complication rates, while the ECTR group had a significantly lower postoperative revision rate.\u003c/p\u003e \u003cp\u003eTo further clarify the clinical application value of different CTR surgical techniques, we conducted a single-center retrospective study. We collected the clinical data and follow-up information of patients with CTS who underwent surgical treatment at our institution, and performed a comparative analysis of the clinical efficacy, complications, and prognostic outcomes between OCTR and ECTR. This study aims to provide real-world data to support clinical decision-making in the selection of surgical approaches for CTS.\u003c/p\u003e"},{"header":"1. Methods \u0026 methods","content":"\u003cp\u003e This study was approved by the Ethics Committee of Yichang Central People\u0026rsquo;s Hospital and performed in accordance with the Declaration of Helsinki (2026-021-01).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Inclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for this study are as follows: (1) a clinical diagnosis of CTS based on symptoms and physical examination findings; (2) electrophysiological findings consistent with the diagnostic criteria for CTS, characterized by prolonged motor latency, reduced amplitude of the median nerve at the wrist, prolonged sensory latency, reduced amplitude, slowed conduction velocity, and, in severe cases, absence of both motor and sensory potentials[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e];(3) Failure of a 2-month conservative treatment regimen; (4) Patients with unilateral disease; (5) Follow-up period exceeding 6 months, with a comprehensive dataset.\u003c/p\u003e \u003cp\u003eThe exclusion criteria were as follows: (1) Patients with CTS who did not undergo surgical treatment in accordance with the study protocol;(2) Patients with a mass within the carpal tunnel detected via ultrasonographic examination;(3) Patients with bony or articular abnormalities of the carpal tunnel indicated by plain radiography;(4) Patients with a concurrent diagnosis of osteoarthritis, rheumatoid arthritis, or gouty arthritis involving the wrist joint;(5) Patients with a follow-up period of less than 6 months or incomplete clinical datasets.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Clinical data\u003c/h2\u003e \u003cp\u003eBetween January 2022 and December 2024, a total of 112 patients were diagnosed with CTS. Of these, 82 patients who met the aforementioned inclusion criteria were enrolled in this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A comprehensive retrospective review was performed on the clinical data and electrophysiological characteristics of the enrolled patients.\u003c/p\u003e \u003cp\u003eBaseline clinical data included age, sex, and body mass index (BMI). The outcome measures included the symptom severity score (SSS) and functional status score (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ), the Visual Analogue Scale (VAS), as well as electrophysiological parameters of the median nerve: sensory nerve conduction velocity (SNCV), sensory nerve action potential (SNAP) amplitude, distal motor latency (DML), and compound muscle action potential (CMAP) amplitude. Long-term complications and reoperation rates were recorded. All questionnaires were completed independently by each patient.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Boston Carpal Tunnel Questionnaire\u003c/h2\u003e \u003cp\u003eThe Boston Carpal Tunnel Questionnaire (BCTQ) was developed by David W. Levine from Brigham and Women\u0026rsquo;s Hospital in Boston, USA, in 1993. It consists of two core domains: the Symptom Severity Score (SSS) and the Functional Status Score (FSS). The SSS evaluates the frequency and severity of core CTS symptoms, while the FSS assesses the impact of CTS on patients\u0026rsquo; ability to perform activities of daily living (ADLs). The clinically recognized thresholds for the Patient Acceptable Symptom State (PASS) are an SSS\u0026thinsp;\u0026le;\u0026thinsp;1.82 and an FSS\u0026thinsp;\u0026le;\u0026thinsp;1.50; scores below these thresholds indicate that the patient has achieved clinically satisfactory recovery of symptoms and functional status[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Neuroelectrophysiology examination\u003c/h2\u003e \u003cp\u003eThe summary of the 2024 Clinical Practice Guideline for CTS issued by the American Academy of Orthopaedic Surgeons (AAOS) has repeatedly highlighted neuroelectrophysiological assessment and identified it as a core reference modality for CTS diagnosis[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. SNCV, SNAP, DML, and CMAP of the median nerve play a critical role in the diagnosis, severity stratification, and prognostic assessment of CTS[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Statistical analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 25.0 software (SPSS Inc., Chicago, IL, USA). Categorical variables were presented as frequencies and percentages, and intergroup comparisons were conducted using the chi-square test. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD). The Shapiro-Wilk test was used to verify the normality of data distribution, and Levene\u0026rsquo;s test was applied to assess the homogeneity of variances between groups. For intergroup comparisons of continuous variables, the independent samples t-test was used when data were normally distributed with homogeneous variances, while Welch\u0026rsquo;s corrected t-test was adopted in cases of heterogeneous variances. The Mann-Whitney U test was performed for data with a non-normal distribution. A \u003cem\u003eP\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate a statistically significant difference.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Surgical Procedure","content":"\u003cp\u003eOCTR was performed using the mini-palm open release technique, which was first described by G.S. Bromley[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. ECTR was conducted with a specialized technique using a transparent, colorless plastic protective sheath fabricated from a syringe, which was first reported by Bo Liu[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eBetween January 2022 and December 2024, a total of 112 patients were diagnosed with CTS. Of these, 82 patients (55 females and 27 males) met the inclusion criteria and were enrolled in this study. The median follow-up duration of all patients was 34 months (range, 13\u0026ndash;48 months), and no vascular or neurological complications occurred in any patient during the follow-up period. Among the enrolled patients, 47 cases underwent OCTR, and the remaining 35 cases received ECTR.\u003c/p\u003e \u003cp\u003eWe first compared the preoperative baseline characteristics between the two groups of patients. There were no statistically significant differences in age, sex distribution, and body mass index (BMI) between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that the demographic characteristics of the two groups were comparable (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). No statistically significant differences were observed in the preoperative VAS score, BCTQ-SSS, and BCTQ-FSS between the OCTR group and the ECTR group (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). For the preoperative neuroelectrophysiological parameters, including SNCV, SNAP amplitude, DML, and CMAP amplitude, no significant differences were detected between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). These results confirmed that the baseline characteristics of the two groups were well-balanced and comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient demographics characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEndoscopic(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.42\u0026thinsp;\u0026plusmn;\u0026thinsp;9.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.9647\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (M/F)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(31.91)/32(68.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(35.29%)/23(65.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8926\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft/Right\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(40.43%)/28(59.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(37.14%)/22(62.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7633\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eBMI\u003c/em\u003e, body mass index;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt the final follow-up, both groups achieved remarkable improvements in clinical symptom scores and nerve electrophysiological indicators relative to their preoperative baseline levels. In the intergroup comparison, no statistically significant differences were found in the VAS scores (0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49 vs 0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.7132), BCTQ-SSS scores (12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13 vs 12.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.6103), and BCTQ-FSS scores (9.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85 vs 9.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.8630) between the OCTR and ECTR groups. Consistently, the final follow-up nerve electrophysiological outcomes, including SNCV (46.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57 m/s vs 45.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22 m/s, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.2146), SNAP (15.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51 \u0026micro;V vs 16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79 \u0026micro;V, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.1304), DML (4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 ms vs 4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42 ms, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.3530), and CMAP (12.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31 mV vs 12.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12 mV, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.3121), showed no significant differences between the two groups (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreoperative and postoperative VAS scores, BCTQ scores, and nerve electrophysiological examination outcomes of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePrior to surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eFinal follow-up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEndoscopic\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEndoscopic\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e0.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.7132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCTQ-SSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e22.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e12.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.6103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCTQ-FSS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.63\u0026thinsp;+\u0026thinsp;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e9.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e9.49\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.8630\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSNCV \u003cem\u003e(m/s)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e38.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.3202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e46.51\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e45.71\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.2146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSNAP \u003cem\u003e(\u0026#120583;V)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e12.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.8575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e15.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.1304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDML \u003cem\u003e(ms)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.1163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e4.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.3530\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCMAP \u003cem\u003e(mV)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e9.43\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.7656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e12.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e12.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.3121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eBCTQ-SSS: the symptom severity scale of Boston carpal tunnel questionnaire; BCTQ-FSS: the functional status scale of Boston carpal tunnel questionnaire; CMAP: compound muscle action potential; DML: distal motor latency; SNAP: sensory nerve action potential; SNCV: sensory nerve conduction velocity.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe perioperative outcomes of the two groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The mean operative time was significantly longer in the ECTR group than in the OCTR group (46.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22 min vs 35.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40 min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, the total hospitalization cost of the ECTR group was significantly higher than that of the OCTR group (8059.85 Yuan vs 6995.57 Yuan, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative Outcomes of the Two Groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEndoscopic(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery time\u003c/p\u003e \u003cp\u003e(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCosts (Yuan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6995.57 (5898.34, 7436.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8059.85 (6715.24, 8739.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this single-center retrospective analysis enrolling 82 patients with CTS, we compared the clinical efficacy, perioperative parameters, and long-term follow-up outcomes between ECTR and OCTR. The core finding was that there were no statistically significant differences between the two surgical approaches in terms of postoperative pain relief, functional recovery, and neuroelectrophysiological improvement, whereas OCTR exhibited significant advantages of shorter operative time and lower hospitalization costs. These findings not only fulfill the study objective of clarifying the clinical application value of the two CTR modalities stated in the Introduction but also provide real-world evidence-based support for clinical surgical decision-making in CTS. Meanwhile, the clinical implications and scientific value of these results warrant in-depth interpretation in the context of the existing research landscape and the inherent limitations of the present study.\u003c/p\u003e \u003cp\u003eCTR serves as the first-line definitive treatment for moderate to severe CTS following failure of conservative treatment, and the optimization of its surgical modalities has long been a key research focus in the field of hand surgery[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The results of this study demonstrated that postoperative VAS scores, BCTQ-SSS and BCTQ-FSS scores, as well as median nerve electrophysiological parameters (including SNCV, SNAP amplitude, DML, and CMAP amplitude) were all significantly improved relative to the preoperative baseline in both groups, with no statistically significant differences detected between the two groups. This finding is consistent with the conclusions of the meta-analysis published by Masri et al.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], which confirmed no significant differences between the two surgical modalities in long-term pain relief, functional recovery, and the incidence of complications. Collectively, these data further verify the robust clinical efficacy of both CTR procedures. The randomized controlled trial (RCT) conducted by Joy C et al.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] also demonstrated that although ECTR had short-term advantages in grip strength recovery and pain relief at 1 to 6 weeks postoperatively, this difference completely disappeared by 12 weeks after surgery. This finding aligns well with the long-term follow-up results (median follow-up duration of 34 months) of the present study, indicating consistent long-term efficacy between the two surgical modalities. Furthermore, neuroelectrophysiological parameters are recognized as the core benchmarks for evaluating postoperative recovery in CTS. Significant improvements in these parameters directly reflect the efficacy of median nerve decompression [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which provides a solid theoretical foundation for the efficacy assessment framework employed in the present study.\u003c/p\u003e \u003cp\u003eAbout perioperative parameters, the present study revealed that OCTR was associated with a significantly shorter operative time (35.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40 min vs. 46.91\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22 min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and significantly lower hospitalization costs (6995.57 Yuan vs. 8059.85 Yuan, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with ECTR. This finding aligns with the conclusions of a portion of prior studies, while conflicting with those reported in other published investigations. Studies by Teng et al.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] and Zheng et al.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] reported that endoscopic carpal tunnel release had a shorter operative time compared with open surgery. Such discrepancies in study findings may be attributed to variations in surgical modality selection, surgeon operative proficiency, and the severity of patients\u0026rsquo; CTS. Notably, in the present study, the ECTR procedure was performed using a novel endoscopic technique, which required preparation of a transparent, colorless plastic protective sheath fabricated from a standard syringe. In contrast, the modified mini-palm open release technique adopted for OCTR provided adequate surgical field exposure and a simplified operative workflow, thus resulting in a shorter operative duration. A 2024 study by Thomas et al.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] also reported that conventional ECTR generally required a longer operative time than conventional open surgery, as it necessitated the establishment of an endoscopic working channel and precise anatomical localization of carpal tunnel structures. Meanwhile, the utilization of endoscopic equipment was associated with increased hospitalization costs, which is consistent with the finding of higher hospitalization costs for ECTR in the present study.\u003c/p\u003e \u003cp\u003eFrom a pathophysiological perspective, both surgical procedures effectively improve clinical symptoms and neuroelectrophysiological parameters in patients with CTS. The core mechanism underlying these improvements is the release of the transverse carpal ligament (TCL), which relieves mechanical compression on the median nerve and restores its blood supply and conduction function[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The 2025 updated Clinical Practice Guideline for CTS issued by the AAOS[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] explicitly states that median nerve SNCV, SNAP, DML, and CMAP are core parameters for evaluating the severity of CTS and postoperative recovery, and the degree of their improvement directly reflects the efficacy of median nerve decompression. Preclinical animal studies have demonstrated that release of the TCL can significantly reduce median nerve thickness, improve nerve conduction function, and downregulate the levels of inflammatory cytokines within the carpal tunnel, which constitutes the key pathophysiological basis underlying the clinical efficacy of both surgical procedures[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In the present study, significant elevations in SNCV, SNAP amplitude and CMAP amplitude, alongside significant shortening of DML, were observed postoperatively in both patient groups. These findings indicate that both surgical modalities can effectively achieve adequate decompression of the median nerve, which is consistent with the conclusions of the 2024 CTS review by Alrayes et al.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The review confirmed that complete release of the TCL, whether performed via an open or endoscopic surgical approach, can effectively restore median nerve function. Furthermore, the study on the application of the BCTQ scale in Chinese populations conducted by Lue et al.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] found that the Chinese version of the BCTQ is a reliable and valid instrument for evaluating symptom severity and functional status in patients with CTS. In the present study, the significant postoperative improvement in BCTQ scores in both groups further verified the efficacy of the two surgical modalities in alleviating symptoms and restoring hand function, which is fully consistent with the conclusions of the study.\u003c/p\u003e \u003cp\u003eThe clinical value of the present study mainly lies in providing precise evidence-based reference for surgical decision-making of CTS in real-world clinical settings. As the most prevalent upper extremity peripheral nerve entrapment disorder worldwide, CTS has a prevalence rate of 9.6% among office workers in China, has been included in China\u0026rsquo;s statutory list of occupational diseases, and a large number of patients undergo CTR annually[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Selecting a more cost-effective and efficient surgical modality while ensuring consistent therapeutic efficacy is of great clinical and socioeconomic significance for alleviating the healthcare burden and improving patients\u0026rsquo; healthcare experience. The present study demonstrated that OCTR and ECTR achieved comparable clinical efficacy, whereas OCTR exhibited distinct advantages in operative time and medical costs, making it particularly suitable for primary healthcare institutions and cost-sensitive patients. As a minimally invasive surgical modality, ECTR offers the benefits of minimal surgical trauma and inconspicuous postoperative scarring, and can be prioritized for younger patients with high cosmetic demands. These findings are consistent with the results reported by Rajapandian et al.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], which stated that the cosmetic advantage of ECTR represents a core value for its clinical application, while the high efficiency and cost-effectiveness of OCTR are more favorable for large-scale clinical implementation.\u003c/p\u003e \u003cp\u003eSeveral limitations of the present study should be objectively acknowledged. First, this study was a single-center retrospective analysis with a limited enrolled sample size of 82 patients. Furthermore, only patients with unilateral CTS were included, which inevitably restricts the generalizability of the findings. The results cannot be extrapolated to complex clinical scenarios, including patients with bilateral CTS or those complicated with other joint disorders. Second, the median follow-up duration of this study was 34 months. Although this meets the standard for medium-to-long-term follow-up, it remains insufficient to evaluate the long-term efficacy and complication risk of the two surgical modalities beyond 5 years postoperatively. Previous studies have indicated that a minimum follow-up period of 5 years is required for patients after CTS surgery to assess the long-term stability of median nerve function and the risk of reoperation[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, no standardized and unified postoperative rehabilitation protocol was implemented for the enrolled patients in the present study, while rehabilitation interventions have a well-recognized critical impact on postoperative functional recovery after CTS surgery[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This may act as a potential confounding factor influencing the differences in functional recovery between the two groups. Finally, no blinded assessment of outcome measures was performed in the present study, which may introduce subjective bias; this is a well-recognized common limitation inherent to retrospective study designs. Multicenter, large-sample, prospective randomized controlled trials (RCTs) are warranted in the future to further validate the findings and conclusions of the present study.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study confirms that both ECTR and OCTR yield good mid-term outcomes in the treatment of CTS, and there is no significant difference in efficacy between the two procedures. However, OCTR offers the advantages of shorter operative time and lower hospitalization costs, while ECTR is characterized by minimal trauma and a cosmetically pleasing postoperative scar. In clinical practice, the choice of surgical approach can be tailored to the patient\u0026rsquo;s specific needs, the technical capabilities of the medical institution, and the surgeon\u0026rsquo;s experience.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflicts of interest\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Written informed consent for publication was obtained from all participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003cp\u003eThis study was approved by the Ethics Committee of Yichang Central People's Hospital and performed in accordance with the Declaration of Helsinki (2026-021-01).\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThere is no funding source.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZZ: Manuscript writing and data collection， YL: Data collection, HY: Performer of surgery, SB and KS: Supervision of the research process and revision of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePripotnev S, Mackinnon SE. Revision of Carpal Tunnel Surgery. J Clin Med 2022, 11(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLatzka EW, Henning PT, Pourcho AM. Sonographic Changes After Ultrasound-Guided Release of the Transverse Carpal Ligament: A Case Report. Pm r. 2018;10(10):1125\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCognet JM, Apard T, Garret J, Martinel V, Mares O. Ultrasound-guided carpal tunnel release: Anatomical landmarks, surgical technique, and literature review. Hand Surg Rehabil. 2025;44(5):102201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Y, Deng S, Xu L, Li S, Ji Z. The application of ultrasound-guided percutaneous transforaminal endoscopy in treating carpal tunnel syndrome. J Orthop Surg Res. 2025;20(1):747.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBland JD. Treatment of carpal tunnel syndrome. Muscle Nerve. 2007;36(2):167\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoutros M, Awad G, Saad JP, Hamdan KB, Hamdan MB, Elhassan B. Comparative efficacy and safety of endoscopic, open, and mini-open techniques for carpal tunnel release: A meta-analysis. J Hand Microsurg. 2026;18(1):100392.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWellborn PK, Jeffs AD, Allen AD, Zaidi ZS, Luther GA. Revision Carpal Tunnel Release with Endoscopic Technique: Clinical Outcomes and Intraoperative Findings. J Hand Surg. 2025;50(9):1075\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacDermid JC, Richards RS, Roth JH, Ross DC, King GJW. Endoscopic versus open carpal tunnel release: A randomized trial. J Hand Surg Am. 2025;50(8):979\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng W, Zhang M, Zhao LL, Li P, Yang B, Xiang ST, Sun Y, Yu XJ. A Novel Cannula Crafted From Disposable Syringes for Endoscopic Carpal Tunnel Release in the Treatment of Carpal Tunnel Syndrome. Surgical Innovation; 2026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu J, Jia X, Zhao Y, Yang J. A Modified Surgical Technique for Endoscopic Carpal Tunnel Release. Arthrosc Tech. 2025;14(7):103576.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDondapati A, Carroll TJ, Hammert WC, Mahmood B. Predictors of Successful Outcomes Following Revision Carpal Tunnel Release. J Hand Surg Am. 2025;50(12):1521. e1521-1521 e1529.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChong HH, See A, Kulkarni K, Collaborators E. National trends in the initial diagnosis and management of carpal tunnel syndrome: results from the ELECTS (ELEctrophysiology in Carpal Tunnel Syndrome) study. Ann R Coll Surg Engl. 2024;106(1):64\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75(11):1585\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaughan G, Kim J, Arbon J, Roca H, Garcia BN, Kazmers NH. Establishing the Patient Acceptable Symptoms State for the Boston Carpal Tunnel Questionnaire in a Postoperative Carpal Tunnel Surgery Population. J Hand Surg Am. 2025;50(2):156\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro LM, Kamal RN, Management of Carpal Tunnel Syndrome Work, American Academy of Orthopaedic S. American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome. J Am Acad Orthop Surg. 2025;33(7):e356\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePadua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C, Caliandro P, Hobson-Webb LD. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBromley GS. Minimal-incision open carpal tunnel decompression. J Hand Surg Am. 1994;19(1):119\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu B, Wu F. Initial Outcomes of a Novel High-Visibility Endoscopic Carpal Tunnel Release Technique. J Wrist Surg. 2021;10(1):64\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HB, Ha JW, Kang HT, Park M, Lee JK. Comparative Outcomes of Revision Carpal Tunnel Release with External Neurolysis versus Primary Carpal Tunnel Release: A Propensity-Matched Study. J Hand Surg Asian Pac Vol. 2025;30(6):641\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Masri J, Chanbour H, Ghazi M, El Masri D, Salameh P, Liles C, Hill JB, Zuckerman SL. Endoscopic Versus Open Carpal Tunnel Release: An Umbrella Review and a Meta-analysis. Ann Plast Surg. 2024;92(6):677\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWaki T, Sato Y, Tsukamoto K, Yamada E, Yamamoto A, Ibara T, Sasaki T, Kuroiwa T, Nimura A, Sugiura Y, et al. Effectiveness of Comprehensive Video Datasets: Toward the Development of an Artificial Intelligence Model for Ultrasonography-Based Severity Diagnosis of Carpal Tunnel Syndrome. J Ultrasound Med. 2025;44(3):557\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeng X, Xu J, Yuan H, He X, Chen H. Comparison of Wrist Arthroscopy, Small Incision Surgery, and Conventional Surgery for the Treatment of Carpal Tunnel Syndrome: A Retrospective Study at a Single Center. Med Sci Monit. 2019;25:4122\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZheng D, Wu Z, Cheng S, Li L, Chang J. A comparative study on efficacy of modified endoscopic minimally invasive treatment and traditional open surgery for primary carpal tunnel syndrome. J Orthop Surg Res. 2023;18(1):511.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas TL, Goh GS, Beredjiklian PK. Direct Variable Cost Comparison of Endoscopic Versus Open Carpal Tunnel Release: A Time-Driven Activity-Based Costing Analysis. J Am Acad Orthop Surg. 2024;32(17):777\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi Y, Zhou Q, Luo S, Lin W, Huang X, Cao Y. [Effect of needle-knife release on the median nerve and transverse carpal ligament in rabbits with carpal tunnel syndrome]. Nan fang yi ke da xue xue bao = J South Med Univ. 2025;45(11):2358\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlrayes MS, Altawili M, Alsaffar MH, Alfarhan GZ, Owedah RJ, Bodal IS, Alshahrani NAA, Assiri AAM, Sindi AW. Surgical Interventions for the Management of Carpal Tunnel Syndrome: A Narrative Review. Cureus. 2024;16(3):e55593.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLue YJ, Lu YM, Lin GT, Liu YF. Validation of the Chinese version of the Boston Carpal Tunnel Questionnaire. J Occup Rehabil. 2014;24(1):139\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeng B, Chen K, Zhu X, Ip WY, Andersen LL, Page P, Wang Y. Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study. BMC Public Health. 2021;21(1):57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRajapandian R, Moti Wala S, Aledani EM, Samuel EA, Ahmad K, Manongi NJ, Rauf Butt S. Endoscopic Versus Open Carpal Tunnel Release: A Systematic Review of Outcomes and Complications. Cureus. 2024;16(7):e64991.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahan R, Garoosi K, Enthoven LF, Gehring M, Greyson M. Reoperation Rates and Short-Term Complications Following Endoscopic vs. Open Carpal Tunnel Release: A Longitudinal Analysis. Hand (N Y) 2025:15589447251333817.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewington L, Madan I, Sandford F. Driving, work, wound care and rehabilitation after carpal tunnel release: Consensus recommendations from a UK Delphi study. Hand Ther. 2022;27(3):71\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"carpal tunnel syndrome, endoscope, neurolysis, neuroelectrophysiology","lastPublishedDoi":"10.21203/rs.3.rs-9123689/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9123689/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo compare the efficacy of endoscopic carpal tunnel release and open carpal tunnel release in the treatment of carpal tunnel syndrome.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA retrospective analysis was performed on clinical data of 112 patients with carpal tunnel syndrome admitted from January 2022 to December 2024. The BCTQ-SSS, BCTQ-FSS, pain VAS, median nerve electrophysiological indices (SNCV, SNAP amplitude, DML, CMAP amplitude), and complications were assessed and documented.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAccording to the predefined inclusion and exclusion criteria, 82 of 112 patients were included, with a median follow-up of 34 months (range 13\u0026ndash;48 months). 35 patients underwent ECTR and 47 underwent OCTR. At the final follow-up, both groups achieved significant improvements in VAS score, BCTQ-SSS, BCTQ-FSS, and all electrophysiological parameters (SNCV, SNAP, DML, CMAP) versus preoperative baseline. No significant intergroup differences were found in these postoperative outcomes (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The ECTR group had significantly shorter operative time and lower hospitalization cost than the OCTR group (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis single-center retrospective study with short-term follow-up has inherent limitations, yet our results confirm favorable clinical efficacy for both surgical approaches. Endoscopic carpal tunnel release provides minimal invasiveness and less scarring, whereas open release features shorter operation time and lower inpatient costs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLevel of evidence\u003c/b\u003e\u003c/p\u003e \u003cp\u003eLevel IV retrospective case series.\u003c/p\u003e","manuscriptTitle":"A Comparative Study of Endoscopic Carpal Tunnel Release and Open Carpal Tunnel Release for Carpal Tunnel Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-20 12:06:04","doi":"10.21203/rs.3.rs-9123689/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e15f6875-5fa9-4b65-87b0-13a61aec7980","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T04:25:09+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 12:06:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9123689","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9123689","identity":"rs-9123689","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}