The Two Portal Technique of Decompression of the Median Nerve

Abstract

Open median nerve decompression through a longitudinal palmar incision is considered the gold standard. Endoscopic carpal tunnel release has been demonstrated as an effective alternative to preserve anatomical structures that may be transected during open carpal tunnel release. Specifically the palmar skin and the superficial cutaneous nerve branches are spared by endoscopic techniques. This may help in earlier recovery of strength and decreased tenderness, which facilitates return to work and activities of daily living. Single portal and two portal techniques were introduced simultaneously. The Chow two-portal technique represents the preferred concept at our institution (Chow 1990). By using a second portal, allowing direct visualization of the superficial palmar arch, we find the endoscopic procedure safer and technically less demanding (Brown et al. 1992). Analysis of the costs involved in each technique demonstrates another advantage of the two portal method, as no special camera equipment is needed and the single knives used with the one portal technique according to Agee are more expensive (Agee et al. 1992).