Endoscopic Carpal Tunnel Release (EndoTech Supraretinacular Technique)

Abstract

Carpal tunnel syndrome is the most common peripheral entrapment neuropathy. It is caused by increased pressure inside the carpal tunnel compressing the median nerve. Symptoms typically include pain and paresthesia’s in the median nerve distribution (thumb through radial aspect of ring finger), often exacerbated at night. Surgical options include open or endoscopic release of the transverse carpal ligament. The open technique typically involves a longitudinal incision through the palm with division of the palmar fascia and the transverse carpal ligament. Unfortunately, the open technique does have increased risk of certain complications such as painful scars and pillar pain compared to the minimally invasive techniques. Endoscopic carpal tunnel surgery was first reported by Dr. Okutsu in 1989. There are several types of endoscopic techniques. These include either a plane of dissection superficial or deep to the transverse carpal ligament. There are also either single incision (single portal) or double incision (two-portal) techniques for the deep plane of dissection. The most common endoscopic techniques involve placing an endoscope deep to the transverse carpal ligament from either a proximal incision or a proximal and distal approach. While visualizing the transverse carpal ligament, it is divided, leaving the superficial skin, palmar fascia and muscle intact. We have recently developed a superficial endoscopic approach (EndoTech^® endoscopic carpal tunnel release). This procedure allows us to maintain visualization of the transverse carpal ligament and the median nerve throughout the entire procedure.