Carpal tunnel release surgery is one of the most common surgical procedures for the hand, but most people are not aware that there are two different ways to surgically repair your carpal ligament.

The Open Carpal Tunnel Release (OCTR) procedure – is when a surgeon makes an incision in the palm of your hand so the surgeon can view and operate on structures within the wrist through an incision.

The Endoscopic Carpal Tunnel Release (ECTR) procedure – is a less invasive approach in which the surgeon inserts a specialized cannula with a tiny camera through a smaller incision made at the base of your wrist.

Each procedure has been shown to resolve carpal tunnel pain and numbness, but they involve very different techniques and recovery times.

“Thankfully, nerve pain is the most predictable complaint to be cured with a carpal tunnel release, typically with the patient experiencing immediate relief,” says Nathan Lesley, MD, an orthopedic surgeon who specializes in hand and upper extremity surgery and founder and CEO of the Hand to Shoulder Center in Fort Worth, Texas.

Both endoscopic and open surgery relieve pressure on the median nerve as it passes through the carpal tunnel, a narrow space within the wrist. During both procedures, surgeons cut the ligament at the top of the carpal tunnel that had been constricting the median nerve, giving the nerve more room.

If you don’t know the difference between Open and Endoscopic Carpal Tunnel Release and haven’t decided which type of surgery to have, learn more about both procedures so you can make an informed decision on which path is best for you.

Open Carpal Tunnel Release

Surgeons make a 1- to 3-inch incision in the palm of the hand near the wrist, exposing the carpal tunnel from above. Then, they cut through the ligament. Afterward, they stitch up the incision, dress the wound, and place the wrist in a splint to stabilize it as it heals.

“Because traditional open carpal tunnel surgery approaches the median nerve from the outside, the surgeon must first cut through skin, subcutaneous fatty tissue, palmar fascia, and muscle in order to visualize the transverse carpal ligament, which serves as the ‘roof’ of the carpal tunnel,” Lesley says.

The open procedure tends to require additional healing compared to the endoscopic procedure.1 The incision in your palm is very tender during the recovery period. You will not be able to apply pressure in your palm for about 4 to 6 weeks. If your usual activities include strenuous or repetitive motions involving your wrist, your doctor may ask you to wait for 6 to 8 weeks before resuming activities.

Endoscopic Carpal Tunnel Release

Surgeons make a ½-inch incision in the wrist, then insert a small cannula with a camera that allows them to view the carpal tunnel from within on a monitor giving them high-definition visualization.

“The ‘roof’ of the carpal tunnel is viewed from the inside instead of cutting into the palm,” Lesley says. “The median nerve lies close to the skin in this area, so with minimal dissection, the carpal tunnel is identified.”

Within the cannula, a tiny blade allows the surgeon to cut through the transverse carpal ligament from its underside, which creates more space for the median nerve within the wrist. The cannula is removed, and the surgeon uses two stitches to close the incision before covering the site with an adhesive bandage. For most patients, there is very little pain after the procedure, only requiring an over-the-counter pain reliever.  

You may be able to resume your usual activities within a few days. If you perform strenuous motions at work, your doctor may ask you to wait a month before you return to your full routine.