Carpal Tunnel Release Classification
Carpal tunnel release (CTR) procedures are classified based on the surgical approach used to divide the transverse carpal ligament and decompress the median nerve.
1. Open Carpal Tunnel Release (OCTR)
- Traditional open technique:
- Standard longitudinal incision (3–5 cm) over the carpal tunnel.
- Complete visualization of the transverse carpal ligament.
- Often performed under local or regional anesthesia.
- Mini-open technique:
- Smaller incision (1.5–3 cm).
- Less soft tissue dissection, faster recovery.
- Limited exposure, but safer than blind endoscopic in some hands.
2. Endoscopic Carpal Tunnel Release (ECTR)
- Single-portal technique (e.g., Agee):
- Entry through a proximal forearm or wrist incision.
- Endoscope introduced to visualize and cut the ligament.
- Two-portal technique (e.g., Chow):
- One portal for the endoscope, another for the cutting instrument.
- Better visualization of structures.
Advantages: Shorter recovery time, less scar tenderness. Disadvantages: Steep learning curve, risk of incomplete release or iatrogenic injury.
3. Ultrasound-Guided Carpal Tunnel Release
- Percutaneous procedure with real-time imaging.
- Minimally invasive: no direct palm incision.
- Still under evaluation; requires advanced skill in musculoskeletal ultrasound.
4. Other Techniques (Experimental)
- Thread Carpal Tunnel Release (TCTR) – uses a looped thread under imaging guidance.
- Laser-assisted / Robotic-assisted techniques – rare, not standard.
Summary Table
| Technique | Invasiveness | Visualization | Recovery | Risk of Iatrogenic Injury |
|---|---|---|---|---|
| Open | High | Excellent | Slower | Low (if careful) |
| Mini-open | Moderate | Good | Faster | Low |
| Endoscopic | Low | Good (with experience) | Fast | Moderate (learning curve) |
| US-guided | Minimal | Indirect | Fast | Unknown / evolving |
Note: Choice of technique depends on surgeon expertise, patient anatomy, and available resources.