Forty-three patients (50 hands) with clinically and electrophysiologically confirmed carpal tunnel syndrome were included in a prospective study to determinate the clinical outcome and electrophysiological recovery of the median nerve after endoscopic transection of the transverse carpal ligament (TCL). Evaluation included a questionnaire for symptoms, physical examination, grip force measurements, and electrophysiological testing before surgery and at weeks 4 and 20 after surgery. As compared to the preop baseline, the rates of permanent paraesthesia, pain, the presence of Tinel's sign, and thenar atrophy decreased significantly. The majority (94%) of the patients had no residual disturbances and were satisfied with the results. Complications were observed in 4.5%, and the treatment had to be changed to an open release. Nerve conduction studies (NCS) showed significant improvement, but many were still abnormal after 4 months. Since failure of improvement could not be predicted by the electrophysiological data, monitoring the postoperative nerve conduction is not very sensitive in characterising the individual clinical course. Our patients were in hospital for 3.3 days. The time of return to work differed between patients that were self employed (4.3 days) and those working as employees (19 days).