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Carpal tunnel release is highly effective, but surgeons continue to debate whether an endoscopic approach produces a better overall recovery than traditional open release. This randomized trial compared the two techniques across symptom severity, complications, pain, grip strength and return to work. Both procedures produced substantial improvement, and the major outcome measures were broadly comparable over follow-up. Endoscopic release offered some early advantages in pain and grip strength, but these differences narrowed over time. The trial therefore supports the view that both techniques are effective and that the choice should be driven by surgeon expertise, patient preference, anatomy and resource considerations rather than expectations of a dramatic long-term functional difference. The study also highlights an important issue in procedural comparisons: early recovery benefits can exist without a meaningful difference in ultimate outcome. For HCPs, the practical takeaway is to set realistic expectations. Endoscopic release may allow a somewhat quicker early recovery in some patients, but open release remains an effective standard approach. Shared decision-making should incorporate incision-related concerns, work demands, previous surgery and the local complication profile of the surgeon or centre.
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Carpal tunnel release is highly effective, but surgeons continue to debate whether an endoscopic approach produces a better overall recovery than traditional open release. This randomized trial compared the two techniques across symptom severity, complications, pain, grip strength and return to work. Both procedures produced substantial improvement, and the major outcome measures were broadly comparable over follow-up. Endoscopic release offered some early advantages in pain and grip strength, but these differences narrowed over time. The trial therefore supports the view that both techniques are effective and that the choice should be driven by surgeon expertise, patient preference, anatomy and resource considerations rather than expectations of a dramatic long-term functional difference. The study also highlights an important issue in procedural comparisons: early recovery benefits can exist without a meaningful difference in ultimate outcome. For HCPs, the practical takeaway is to set realistic expectations. Endoscopic release may allow a somewhat quicker early recovery in some patients, but open release remains an effective standard approach. Shared decision-making should incorporate incision-related concerns, work demands, previous surgery and the local complication profile of the surgeon or centre.
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