Carpal tunnel syndrome is one of the most common nerve entrapments in the body. Familiarity with the median nerve anatomy and its potential anatomical variations is crucial to performing a safe surgery. The procedure itself can be performed by open, endoscopic, or ultrasound-guided mini-open or looped thread technique. To date, there is no long-term superiority of one technique over the other. The key to success is to perform complete release of the transverse carpal ligament while avoiding injury to the neurovascular structures.