{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:01:04Z","timestamp":1786122064098,"version":"build-2736575974"},"reference-count":76,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Minimally invasive carpal tunnel release (CTR) approaches, including endoscopic and ultrasound-guided, encompass a range of distinct techniques. These approaches have been increasingly adopted across both surgical and non-surgical specialties. However, the literature frequently groups the techniques into broad categories, obscuring clinically meaningful differences in transection mechanism, safety profile, and learning curve. Methods: This narrative review organizes minimally invasive CTR into eight distinct techniques, two endoscopic and six ultrasound-guided, classified by their primary transection mechanism. Results: Single-portal endoscopic CTR has the largest evidence base, with network meta-analysis data demonstrating significant early functional advantages over open CTR. Among ultrasound-guided techniques, the retractable retrograde blade is the most widely adopted, with randomized trial data supporting comparable outcomes to mini-open CTR. Hook-knife retrograde and thread-loop techniques have demonstrated feasibility and durable outcomes, though experience is concentrated among a few high-volume operators. The antegrade cutting, pinhole scalpel, and needle-knife have more limited evidence. Earlier return to work is the most reproducible benefit across all minimally invasive approaches. Endoscopic CTR carries a modestly higher revision rate, while long-term data for ultrasound-guided techniques remain lacking. Conclusions: This mechanism-based classification highlights important differences between techniques in safety features, evidence maturity, and learning curves. Head-to-head trials comparing endoscopic and ultrasound-guided techniques and device-specific registries with standardized outcome reporting are needed to inform evidence-based adoption.<\/jats:p>","DOI":"10.3390\/jcm15166130","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:01:36Z","timestamp":1786089696000},"page":"6130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Mechanism-Based Classification and Review of Endoscopic and Ultrasound-Guided Carpal Tunnel Release"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6541-7675","authenticated-orcid":false,"given":"Malka","family":"Korenblit","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz, Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7953-7983","authenticated-orcid":false,"given":"Evan J.","family":"Haas","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz, Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-2176","authenticated-orcid":false,"given":"Elena M.","family":"Esch","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz, Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-9817","authenticated-orcid":false,"given":"Lynn","family":"Orfahli","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz, Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8476-4347","authenticated-orcid":false,"given":"Olivier","family":"Mares","sequence":"additional","affiliation":[{"name":"Service de Chirurgie Orthop\u00e9dique et Traumatologique, Centre Hospitalo-Universitaire de N\u00eemes, Avenue du Pr. Debr\u00e9, 30000 N\u00eemes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7933-6089","authenticated-orcid":false,"given":"Mark","family":"Greyson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Colorado Anschutz, Medical Campus, 12631 E 17th Ave, Aurora, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1001\/jama.282.2.153","article-title":"Prevalence of carpal tunnel syndrome in a general population","volume":"282","author":"Atroshi","year":"1999","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S1474-4422(22)00432-X","article-title":"Carpal tunnel syndrome: Updated evidence and new questions","volume":"22","author":"Padua","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2434","DOI":"10.1001\/jama.2022.8481","article-title":"Common Hand Conditions: A Review","volume":"327","author":"Currie","year":"2022","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"292","DOI":"10.5435\/JAAOS-D-21-00949","article-title":"Endoscopic Carpal Tunnel Release: Techniques, Controversies, and Comparison to Open Techniques","volume":"30","author":"Hacquebord","year":"2022","journal-title":"J. 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