Introduction: Pillar pain is one of the common sequelae after carpal tunnel release (CTR), presenting as deep pain or tenderness upon pressure on the thenar and hypothenar regions. It potentially interferes with return to work and patient satisfaction. This narrative review was conducted with a focus on the etiology, emerging therapeutic approaches, and a practical management algorithm for pillar pain.
Materials & Methods: A structured search of PubMed and complementary sources was performed from 2018 up to December 2025. Clinical trials, systematic reviews and meta-analyses, cohort studies, and high-quality narrative reviews addressing pillar pain, risk factors, pathophysiology, or post‑CTR treatments were identified and categorized.
Results & Discussion: The evidence suggests that pillar pain is a self‑limiting condition, and approximately half of the patients may experience it, with most cases resolving within 3 to 6 months. The etiology is multifactorial and includes biomechanical alterations of the carpal arch after division of the transverse carpal ligament, soft‑tissue inflammation or scarring, irritation or neuroma of the palmar cutaneous branch of the median nerve, and central mechanisms. Non‑surgical treatment is the mainstay of management and encompasses patient education and reassurance, occupational hand therapy modalities (desensitization, massage, graded exercises), non‑opioid analgesics and anti‑inflammatory medications. In refractory cases, minimally invasive options such as extracorporeal shock wave therapy (ESWT) and photo biomodulation may be used. Emerging evidence on fractional CO₂ laser therapy for treatment‑resistant pillar pain is promising but still limited. From a preventive standpoint, minimally invasive techniques and appropriate choice of skin closure method may influence short‑term pillar pain.
Conclusion: Pillar pain after CTR is usually benign and transient but requires a stepwise, multimodal approach. Combining patient education, targeted rehabilitation, and non‑opioid pain strategies, with selective use of minimally invasive interventions in refractory cases, offer safe and efficacious treatment.