A technique for dividing the transverse carpal ligament has been developed in order to decrease the incidence of pillar pain. The carpal ligament splits around the flexor carpi radialis (FCR) tendon into two leaves as it approaches its radial attachments. The new approach uses the FCR as a guide to divide these attachments under direct visualization, thereby releasing the carpal tunnel. This technique has been used on 87 hands, with 79 (91%) obtaining complete or partial relief of preoperative symptoms. Pillar tenderness resolved quickly and there were few complications. The FCR approach to carpal tunnel release couples the advantages of direct visualization of the carpal canal contents with the decreased disruption of palmar skin and soft tissues, thereby reducing pillar pain without increasing the risk of surgical complications.