Endoscopic carpal tunnel release using the single proximal incision technique

Abstract

The goal of the single incision endoscopic technique is to avoid an incision on the palmar surface of the hand. As compared with open release and the two-portal endoscopic technique for release of the carpal tunnel, this single incision technique permits the patient to return earlier to work and activities of daily living as a result of less tenderness and earlier return of strength. Safe performance of the technique requires that the surgeon have both a thorough knowledge of the anatomy of the hand and a commitment to master the technical details of the surgical approach. Because the technique is of value strictly to view and divide the TCL, patient selection requires careful preoperative evaluation to exclude those carpal tunnels with pathology that requires direct inspection or surgical treatment. In a prospective study with the redesigned point of entry blade assembly that allows a view of the blade's entry into the ligament, no device-related complications occurred. In considering a surgical approach for endoscopic carpal tunnel release, the authors feel that it is important to recognize the value of an "open" proximal surgical incision designed to directly view the plane between the finger flexor synovium and the deep surface of the TCL. Stab wound "portals" that are widely used in arthroscopic surgery are inadequate for endoscopic carpal tunnel releases. The device and the procedure are designed to obtain an unobstructed view of the underside of the TCL and divide it completely. Additional long-term prospective studies are needed to define the comparative recurrence rates of open versus single incision endoscopic carpal tunnel release surgeries.