Objective To investigate the feasibility of measurement of pressure in the carpal canal before and after endoscopic management of carpal tunnel syndrome. Methods The endoscopic release procedures were performed in 47 wrists with carpal tunnel syndrome in 38 patients. The pressure in the carpal canal was measured in 21 wrists of 16 patients preoperatively and postoperatively in the resting position, the extension position, the flexion position and the Okutsu test position. Results Compared with the pressure in the carpal canal before the operation, the pressure after the operation decreased significantly (P<0.01) in the same position. Conclusion The pressure change before and after the operation could be used to assess the extent of release and avoid the incomplete decompression procedure.