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Dec 24, 2023

History and Evolution of Carpal Tunnel Surgery

First Description of Carpal Tunnel Syndrome

The first article linking compression of the median nerve to the symptoms of carpal tunnel syndrome was published in 1913 by Marie and Foix to the French Neurological Society. In the article, the authors note that "transection of the ligament could stop the development of these [symptoms]." The primary goal of a carpal tunnel release is to transect the transverse carpal ligament to release pressure on the median nerve in the carpal tunnel, but it was not until a decade later that a surgery was described that cut the transverse carpal ligament in these cases of carpal tunnel syndrome.

The History of Carpal Tunnel Surgery

The first reported carpal tunnel release was reported by Dr. Herbert Galloway in 1924 (Amadio; Papatheodorou and Sotereanos). The incisions were relatively large using a 5 to 6-cm incision over the palm. Over time surgeons have attempted to decrease the size of this incision to decrease side effects and improve recovery (Rojo-Manaute et al.).

Evolution of Carpal Tunnel Surgery

Newer image guided techniques have now been published to decrease the size of the incision, minimize complications and allow for a faster recovery.

In 1997, Nakamichi and Tachibana published an endoscopic carpal tunnel release technique to release the carpal tunnel using smaller incisions in the forearm and a camera to guide the surgical release. Various techniques have since been published with varying approaches, including a single 1 to 1.5-cm incision above the wrist or two incisions in the palm and forearm are made (Rojo-Manaute et al.; Nakamichi and Tachibana; Hansen and Majeed; Rojo-Manaute et al.; Hebbard et al.; Chern et al.; Burnham et al.; Petrover et al; Guo et al.; Latzka et al.; Henning et al.; Henning et al.; Apard et al.).

Now newer ultrasound guided carpal tunnel release techniques have been described.

Advantages of Carpal Tunnel Surgery using Ultrasound Guidance

Carpal tunnel surgery using ultrasound guidance uses a forearm incision similar to the endoscopic approach to minimize the recovery from cutting into the palm, however, the ultrasound provides a larger field of view than the endoscopic camera-based approach. The ultrasound allows for both visualization of both the ligament and neurovascular structures (i.e. the nerves) in real time (Rojo-Manaute et al.; Ohuchi et al.; Ohno et al.).

The ultrasound guided approach has been shown to be safe without injury to the nerves and a faster recovery than the “mini-open” technique (Rojo-Manaute et al.; Nakamichi and Tachibana; Petrover et al; Guo et al.; Latzka et al.; Henning et al.; Henning et al.; Apard et al.). The published data shows that 95% of patients were satisfied with the surgical outcomes (Rojo-Manaute et al.; Nakamichi and Tachibana; Petrover et al; Guo et al.; Latzka et al.; Henning et al.; Henning et al.; Apard et al.)

The forearm incision used in the ultrasound guided approach allows the patient to avoid the palmar incision that can lead to a functional decline after the “mini-open” approach (Rojo-Manaute et al.; Mahmood et al.).

The Future of Carpal Tunnel Surgery

An estimated 500,000 carpal tunnel releases are performed annually in the United States (Pourmemari et al).Despite advances in carpal tunnel surgery, currently the majority of carpal tunnel surgery is performed using an open approach. Up to 70 to 80% of carpal tunnel surgeries are performed using a “mini open” approach with an incision size ranging from 2 to 4-cm, and(Papatheodorou and Sotereanos; Kang et al.).

Learn more about carpal tunnel surgery using ultrasound guidance (here).


Amadio PC. The first carpal tunnel release? J Hand Surg Br. 1995 Feb;20(1):40-1.

Apard T, Candelier G. Surgical ultrasound-guided carpal tunnel release. Hand Surg Rehabil. 2017 Oct;36(5):333-337.

Burnham R, Playfair L, Loh E, Roberts S, Agur A. Evaluation of the Effectiveness and Safety of Ultrasound-Guided Percutaneous Carpal TunnelRelease: A Cadaveric Study. Am J Phys Med Rehabil. 2017 Jul;96(7):457-463.

Chern TC, Jou IM, Chen WC, Wu KC, Shao CJ, Shen PC. An ultrasonographic and anatomical study of carpal tunnel, with special emphasis on the safezones in percutaneous release. J Hand Surg Eur Vol. 2009 Feb;34(1):66-71.

Guo D, Guo D, Guo J, Schmidt SC, Lytie RM. A Clinical Study of the Modified Thread Carpal Tunnel Release. Hand (N Y). 2017 Sep;12(5):453-460.

Hansen TB, Majeed HG. Endoscopic carpal tunnel release. Hand Clin. 2014 Feb;30(1):47-53.

Hebbard PD, Hebbard AIT, Tomka J, Appleyard R. Ultrasound-Guided Microinvasive Carpal Tunnel Release Using a Novel Retractable Needle-Mounted Blade: A Cadaveric Study. J Ultrasound Med. 2018 Aug;37(8):2075-2081.

Henning PT, Yang L, Awan T, Lueders D, Pourcho AM. Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: Preliminary Clinical Results. J Ultrasound Med. 2018 Nov;37(11):2699-2706.

Henning T, Lueders D, Chang K, Yang L. Ultrasound-Guided Carpal Tunnel Release Using Dynamic Expansion of the Transverse Safe Zone in a Patient With Postpolio Syndrome: A Case Report. PM R. 2018 Oct;10(10):1115-1118.

Kang HJ, Koh IH, Lee TJ, Choi YR. Endoscopic carpal tunnel release is preferred over mini-open despite similar outcome: a randomized trial. Clin Orthop Relat Res. 2013 May;471(5):1548-54.

Latzka EW, Henning PT, Pourcho AM. Sonographic Changes After Ultrasound-Guided Release of the Transverse Carpal Ligament: A Case Report. PM R. 2018 Oct;10(10):1125-1129.

Mahmood B, Chongshu C, Qiu X, Messing S, Hammert WC. Comparison of the Michigan Hand Outcomes Questionnaire, Boston Carpal Tunnel Questionnaire, and PROMIS Instruments in Carpal Tunnel Syndrome. J Hand Surg Am. 2019 May;44(5):366-373.

Marie P, Foix C. Atrophie isolée de l’éminence thénar d’origine névritique. Rôle du ligament annulaire antérieur du carpe dans la pathogénie de la lésion. Revue Neurologique. 1913;26, 647-649.

Nakamichi K, Tachibana S. Ultrasonographically assisted carpal tunnel release. J Hand Surg Am. 1997 Sep;22(5):853-62.

Ohno K, Hirofuji S, Fujino K, Ishidu T, Kira S, Neo M. Sonographic monitoring of endoscopic carpal tunnel release. J Clin Ultrasound. 2016 Nov 12;44(9):597-599.

Ohuchi H, Hattori S, Shinga K, Ichikawa K, Yamada S. Ultrasound-Assisted Endoscopic Carpal Tunnel Release. Arthrosc Tech. 2016 May 16;5(3):e483-7.

Papatheodorou LK, Sotereanos DG. Treatment recommendations for carpal tunnel syndrome and peripheral nerve repair. Instr Course Lect. 2015;64:273-80.

Petrover D, Silvera J, De Baere T, Vigan M, Hakimé A. Percutaneous Ultrasound-Guided Carpal Tunnel Release: Study Upon Clinical Efficacy and Safety. Cardiovasc Intervent Radiol. 2017 Apr;40(4):568-575.

Rojo-Manaute JM, Capa-Grasa A, Chana-Rodríguez F, Perez-Mañanes R, Rodriguez-Maruri G, Sanz-Ruiz P, Muñoz-Ledesma J, Aburto-Bernardo M, Esparragoza-Cabrera L, Cerro-Gutiérrez MD, Vaquero-Martín J. Ultra-Minimally Invasive Ultrasound-Guided Carpal Tunnel Release: A Randomized Clinical Trial. J Ultrasound Med. 2016 Jun;35(6):1149-57.

Rojo-Manaute JM, Capa-Grasa A, Rodríguez-Maruri GE, Moran LM, Martínez MV, Martín JV. Ultra-minimally invasive sonographically guided carpal tunnel release: anatomic study of a new technique. J Ultrasound Med. 2013 Jan;32(1):131-42.

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