Surgical Management of Carpal Tunnel Syndrome Refractory to Conservative Treatment: A Comparative Analysis of Open versus Endoscopic Carpal Tunnel Release

OBJECTIVE: To analyze factors contributing to conservative treatment failure in carpal tunnel syndrome, evaluate surgical approaches for refractory cases, and discuss the comparative outcomes of open versus endoscopic carpal tunnel release techniques. MATERIALS AND METHODS: This review examined current evidence on carpal tunnel syndrome pathology, focusing on the limitations of traditional conservative management including splinting, NSAIDs, and corticosteroid injections. The analysis evaluated surgical treatment strategies and their long-term outcomes based on recent clinical practice guidelines and meta-analyses. RESULTS: Carpal tunnel syndrome represents the most common peripheral nerve entrapment neuropathy, with increasing numbers of patients showing refractory responses to conservative therapy. Current evidence indicates that carpal tunnel syndrome involves progressive median nerve compression with associated ischemic changes rather than purely inflammatory processes. Traditional first-line treatments demonstrate limitations in addressing underlying pathophysiological changes. Recent studies suggest that repeated steroid injections provide only short-term symptom relief and may not prevent disease progression in patients who require surgical consideration. CONCLUSIONS: Conservative management alone is insufficient for many patients with moderate to severe carpal tunnel syndrome due to the progressive nature of median nerve compression. Surgical intervention, particularly carpal tunnel release, demonstrates superior long-term outcomes. Both open and endoscopic techniques show excellent clinical effectiveness, with endoscopic approaches offering faster recovery and higher initial patient satisfaction, though long-term results are comparable between techniques.