92 patients with carpal tunnel syndrome were randomized to undergo either 1mm ultra-minimally invasive ultrasound-guided carpal tunnel release or 2cm blind mini-open carpal tunnel release. The purpose of this study was to compare the two techniques with regards to postoperative Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, as well as grip strength, time to discontinuation of oral analgesics, full wrist flexion-extension, paresthesia relief, and return to pre-injury function. Outcomes were measured up to 12 months postoperatively. The findings of this trial reported comparable QuickDASH scores at the 12-month follow-up. However, significantly better QuickDASH scores were observed up to the 6-month follow-up in the ultra-minimally invasive release group. Additionally, significantly quicker termination of oral analgesic use, complete wrist extension and flexion, and recovery of pre-injury activity level was reported in the ultra-minimally invasive release group compared to the blind mini-open release group.