A comparative study of clinical efficacy, electrophysiological outcomes, and perioperative parameters between endoscopic carpal tunnel release and open carpal tunnel release for carpal tunnel syndrome

Purpose To compare the clinical efficacy of endoscopic (ECTR) and open (OCTR) carpal tunnel release for carpal tunnel syndrome (CTS) and provide evidence-based surgical guidance. Methods A retrospective cohort study was conducted including 112 consecutive patients with CTS treated at our institution between January 2022 and December 2024. Based on the surgical approach, patients were assigned to an ECTR group or an OCTR group. Surgical selection was determined by patients’ preference, cosmetic expectations, and the surgeon’s technical assessment. Primary outcome measures were the Boston Carpal Tunnel Questionnaire Symptom Severity Score (BCTQ-SSS), Functional Status Score (BCTQ-FSS), and pain assessed by the Visual Analog Scale (VAS). Secondary outcome measures included median nerve electrophysiological indices [sensory nerve conduction velocity (SNCV), sensory nerve action potential (SNAP) amplitude, distal motor latency (DML), and compound muscle action potential (CMAP) amplitude], operative time, hospitalization cost, and postoperative complications. All outcomes were evaluated preoperatively and at the final follow-up (cutoff date: February 2026, with postoperative follow-up duration ranging from 13 to 48 months). Results Eighty-two eligible patients were followed up for a median of 34 months (13–48 months). Both groups showed significant improvements in VAS, BCTQ scores, and electrophysiological parameters versus baseline (all P < 0.05), with no intergroup differences (all P > 0.05). OCTR had significantly shorter operative time and lower cost (both P < 0.001), and complication rates did not differ significantly ( P > 0.05). Conclusion ECTR and OCTR have comparable mid-term efficacy for CTS. OCTR is more cost-effective with shorter operative time, while ECTR’s minimally invasive advantages need further confirmation. Surgical choice should be individualized based on patient preferences and institutional resources.