Endoscopic and Minimally Invasive Carpal Tunnel and Trigger Finger Release

  • Mordechai Vigler
  • Steve K. LeeEmail author


Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy,1,2 with a lifetime incidence estimated at up to 10%.3 The pathophysiology of CTS is thought to be due to compression of the median nerve in the region of the carpal tunnel.4,5 When symptoms are recalcitrant to conservative management, surgical intervention is indicated. The goal of surgery is to decompress the median nerve in the carpal tunnel by transecting the deep transverse carpal ligament (TCL).

Surgical options include open or endoscopic division of the TCL. The gold standard of operative intervention has been the open carpal tunnel release (CTR), which was first popularized by Phalen et al.6,7 In the open technique, this division is typically carried out through a longitudinal palmar incision. Direct vision allows a safe division of the palmar fascia, following which, the TCL is identified and divided longitudinally, with care taken to protect the underlying median nerve.


Carpal Tunnel Syndrome Carpal Tunnel Flexor Tendon Carpal Tunnel Release Trigger Finger 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Duncan K.H., et al., Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: results of a questionnaire. J Hand Surg (Am), 1987 12(3): p. 384–91Google Scholar
  2. 2.
    Pfeffer, G.B., et al., The history of carpal tunnel syndrome. J Hand Surg (Br), 1988 13(1): p. 28–34Google Scholar
  3. 3.
    Stevens, J.C., et al., Carpal tunnel syndrome in Rochester, Minnesota, 1961 to 1980. Neurology, 1988 38(1): p. 134–8PubMedGoogle Scholar
  4. 4.
    Gelberman, R.H., et al., The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am, 1981 63(3): p. 380–3PubMedGoogle Scholar
  5. 5.
    Cobb, T.K., et al., The carpal tunnel as a compartment. An anatomic perspective. Orthop Rev, 1992 21(4): p. 451–3PubMedGoogle Scholar
  6. 6.
    Phalen, G.S., W.J. Gardner, and A.A. La Londe, Neuropathy of the median nerve due to compression beneath the transverse carpal ligament. J Bone Joint Surg Am, 1950 32A(1): p. 109–12PubMedGoogle Scholar
  7. 7.
    Phalen, G.S., The carpal-tunnel syndrome. Clinical evaluation of 598 hands. Clin Orthop Relat Res, 1972 83: p. 29–40CrossRefPubMedGoogle Scholar
  8. 8.
    Semple, J.C. and A.O. Cargill, Carpal-tunnel syndrome. Results of surgical decompression. Lancet, 1969 1(7601): p. 918–9CrossRefPubMedGoogle Scholar
  9. 9.
    Seradge, H. and E. Seradge, Piso-triquetral pain syndrome after carpal tunnel release. J Hand Surg (Am), 1989 14(5): p. 858–62CrossRefGoogle Scholar
  10. 10.
    Chow, J.C., Endoscopic release of the carpal ligament: a new technique for carpal tunnel syndrome. Arthroscopy, 1989 5(1): p. 19–24CrossRefPubMedGoogle Scholar
  11. 11.
    Agee, J.M., et al., Endoscopic release of the carpal tunnel: a randomized prospective multicenter study. J Hand Surg (Am), 1992 17(6): p. 987–95CrossRefGoogle Scholar
  12. 12.
    Nathan, P.A., K.D. Meadows, and R.C. Keniston, Rehabilitation of carpal tunnel surgery patients using a short surgical incision and an early program of physical therapy. J Hand Surg (Am), 1993 18(6): p. 1044–50CrossRefGoogle Scholar
  13. 13.
    Lee, W.P. and J.W. Strickland, Safe carpal tunnel release via a limited palmar incision. Plast Reconstr Surg, 1998 101(2): p. 418–24; discussion 425–6CrossRefPubMedGoogle Scholar
  14. 14.
    Chow, J.C., Endoscopic release of the carpal ligament for carpal tunnel syndrome: 22-month clinical result. Arthroscopy, 1990 6(4): p. 288–96CrossRefPubMedGoogle Scholar
  15. 15.
    Trumble, T.E., et al., Single-portal endoscopic carpal tunnel release compared with open release: a prospective, randomized trial. J Bone Joint Surg Am, 2002 84-A(7): p. 1107–15PubMedGoogle Scholar
  16. 16.
    Palmer, D.H., et al., Endoscopic carpal tunnel release: a comparison of two techniques with open release. Arthroscopy, 1993 9(5): p. 498–508CrossRefPubMedGoogle Scholar
  17. 17.
    Brown, R.A., et al., Carpal tunnel release. A prospective, randomized assessment of open and endoscopic methods. J Bone Joint Surg Am, 1993 75(9): p. 1265–75PubMedGoogle Scholar
  18. 18.
    Kerr, C.D., M.E. Gittins, and D.R. Sybert, Endoscopic versus open carpal tunnel release: clinical results. Arthroscopy, 1994 10(3): p. 266–9CrossRefPubMedGoogle Scholar
  19. 19.
    Okutsu, I., et al., Endoscopic management of carpal tunnel syndrome. Arthroscopy, 1989 5(1): p. 11–8CrossRefPubMedGoogle Scholar
  20. 20.
    Okutsu, I., et al., Measurement of pressure in the carpal canal before and after endoscopic management of carpal tunnel syndrome. J Bone Joint Surg Am, 1989 71(5): p. 679–83PubMedGoogle Scholar
  21. 21.
    Adams, B.D., Endoscopic carpal tunnel release. J Am Acad Orthop Surg, 1994 2(3): p. 179–84PubMedGoogle Scholar
  22. 22.
    Bande, S., L. De Smet, and G. Fabry, The results of carpal tunnel release: open versus endoscopic technique. J Hand Surg (Br), 1994 19(1): p. 14–7Google Scholar
  23. 23.
    Brown, M.G., B. Keyser, and E.S. Rothenberg, Endoscopic carpal tunnel release. J Hand Surg (Am), 1992 17(6): p. 1009–11CrossRefGoogle Scholar
  24. 24.
    Erdmann, M.W., Endoscopic carpal tunnel decompression. J Hand Surg (Br), 1994 19(1): p. 5–13Google Scholar
  25. 25.
    Feinstein, P.A., Endoscopic carpal tunnel release in a community-based series. J Hand Surg (Am), 1993 18(3): p. 451–4CrossRefGoogle Scholar
  26. 26.
    Resnick, C.T. and B.W. Miller, Endoscopic carpal tunnel release using the subligamentous two-portal technique. Contemp Orthop, 1991 22(3): p. 269–77PubMedGoogle Scholar
  27. 27.
    Agee, J.M., H.R. McCarroll, and E.R. North, Endoscopic carpal tunnel release using the single proximal incision technique. Hand Clin, 1994 10(4): p. 647–59PubMedGoogle Scholar
  28. 28.
    Berger, R.A., Endoscopic carpal tunnel release. A current perspective. Hand Clin, 1994 10(4): p. 625–36PubMedGoogle Scholar
  29. 29.
    Nagle, D.J., et al., A multicenter prospective review of 640 endoscopic carpal tunnel releases using the transbursal and extrabursal chow techniques. Arthroscopy, 1996 12(2): p. 139–43CrossRefPubMedGoogle Scholar
  30. 30.
    Seiler, J.G., III, et al., Endoscopic carpal tunnel release: an anatomic study of the two-incision method in human cadavers. J Hand Surg (Am), 1992 17(6): p. 996–1002CrossRefGoogle Scholar
  31. 31.
    Chow, J.C., Endoscopic carpal tunnel release. Two-portal technique. Hand Clin, 1994 10(4): p. 637–46PubMedGoogle Scholar
  32. 32.
    Viegas, S.F., A. Pollard, and K. Kaminksi, Carpal arch alteration and related clinical status after endoscopic carpal tunnel release. J Hand Surg (Am), 1992 17(6): p. 1012–6CrossRefGoogle Scholar
  33. 33.
    Richman, J.A., et al., Carpal tunnel syndrome: morphologic changes after release of the transverse carpal ligament. J Hand Surg (Am), 1989 14(5): p. 852–7CrossRefGoogle Scholar
  34. 34.
    Hueston, J.T. and W.F. Wilson, The aetiology of trigger finger explained on the basis of intratendinous architecture. Hand, 1972 4(3): p. 257–60CrossRefPubMedGoogle Scholar
  35. 35.
    Bonnici, A.V. and J.D. Spencer, A survey of ‘trigger finger’ in adults. J Hand Surg (Br), 1988 13(2): p. 202–3Google Scholar
  36. 36.
    Gilberts, E.C., et al., Prospective randomized trial of open versus percutaneous surgery for trigger digits. J Hand Surg (Am), 2001 26(3): p. 497–500CrossRefGoogle Scholar
  37. 37.
    Benson, L.S. and A.J. Ptaszek, Injection versus surgery in the treatment of trigger finger. J Hand Surg (Am), 1997 22(1): p. 138–44CrossRefGoogle Scholar
  38. 38.
    Gilberts, E.C. and J.C. Wereldsma, Long-term results of percutaneous and open surgery for trigger fingers and thumbs. Int Surg, 2002 87(1): p. 48–52PubMedGoogle Scholar
  39. 39.
    Thorpe AP, Results of surgery for trigger finger. J Hand Surg (Br), 1988 13(2): p. 199–201Google Scholar
  40. 40.
    Hodgkinson JP, et al. Retrospective study of 120 trigger digits treated surgically. J R Coll Surg Edinb, 1988 33(2): p. 88–90PubMedGoogle Scholar
  41. 41.
    Heithoff, S.J., L.H. Millender, and J. Helman, Bowstringing as a complication of trigger finger release. J Hand Surg (Am), 1988 13(4): p. 567–70CrossRefGoogle Scholar
  42. 42.
    Fu, Y.C., et al., Revision of incompletely released trigger fingers by percutaneous release: results and complications. J Hand Surg (Am), 2006 31(8): p. 1288–91CrossRefGoogle Scholar
  43. 43.
    Lorthioir, J., Jr., Surgical treatment of trigger-finger by a subcutaneous method. J Bone Joint Surg Am, 1958 40-A(4): p. 793–5PubMedGoogle Scholar
  44. 44.
    Eastwood, D.M., K.J. Gupta, and D.P. Johnson, Percutaneous release of the trigger finger: an office procedure. J Hand Surg (Am), 1992 17(1): p. 114–7CrossRefGoogle Scholar
  45. 45.
    Bain, G.I. and N.A. Wallwork, Percutaneous A1 pulley release a clinical study. Hand Surg, 1999 4(1): p. 45–50CrossRefPubMedGoogle Scholar
  46. 46.
    Blumberg, N., R. Arbel, and S. Dekel, Percutaneous release of trigger digits. J Hand Surg (Br), 2001 26(3): p. 256–7Google Scholar
  47. 47.
    Bara T, and T. Dorman, [Percutaneous trigger finger release]. Chir Narzadow Ruchu Ortop Pol, 2002 67(6): p. 613–7PubMedGoogle Scholar
  48. 48.
    Cihantimur, B., S. Akin, and M. Ozcan, Percutaneous treatment of trigger finger. 34 fingers followed 0.5–2 years. Acta Orthop Scand, 1998 69(2): p. 167–8CrossRefPubMedGoogle Scholar
  49. 49.
    Patel, M.R. and V.J. Moradia, Percutaneous release of trigger digit with and without cortisone injection. J Hand Surg (Am), 1997 22(1): p. 150–5CrossRefGoogle Scholar
  50. 50.
    Pope, D.F. and S.W. Wolfe, Safety and efficacy of percutaneous trigger finger release. J Hand Surg (Am), 1995 20(2): p. 280–3CrossRefGoogle Scholar
  51. 51.
    Wilhelmi, B.J., et al., Safe treatment of trigger finger with longitudinal and transverse landmarks: an anatomic study of the border fingers for percutaneous release. Plast Reconstr Surg, 2003 112(4): p. 993–9CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Hand Surgery, Department of Orthopaedic SurgeryThe New York University Hospital for Joint Diseases, The New York University School of Medicine, Hand Surgery Service, Bellevue Hospital CenterNew YorkUSA

Personalised recommendations