Initial Outcomes of a Novel High-Visibility Endoscopic Carpal Tunnel Release Technique

Background  A large variety of endoscopic carpal tunnel release methods have been described in efforts to shorten recovery time, reduce scar discomfort, and allow earlier return to work. The majority of existing techniques are the modifications of the Agee, Chow, and Menon techniques, all of which require dedicated equipment that can increase facility and surgical fees for the patient and institution. We present a novel high-visibility endoscopic carpal tunnel release technique that uses common hand surgery instruments available in all surgical units, without requiring disposable or custom devices. Description of Technique  The cases were performed under local anesthesia using routine reusable instruments and a conventional 2.5-mm 30-degree small joint arthroscope. Following proximal dissection, a clear, colorless, plastic shield was created from a standard syringe that offered a 360-degree vision of the carpal tunnel and protection of the median nerve. Release of the transverse carpal ligament was performed under full arthroscopic vision using Metzenbaum dissection scissors. Methods  This pilot study analyses the first nine cases in eight patients who were operated on using this technique, with a minimum of 6 months of follow-up. Results  No peri- or postoperative complications were encountered. All patients demonstrated significant improvements in the Disabilities of the Arm, Shoulder, and Hand score, the Boston Carpal Tunnel Questionnaire score, and a visual analog score for pain. Conclusion  The high-visibility endoscopic carpal tunnel release technique is safe and effective, and offers a viable cost-reducing alternative to the existing endoscopic methods for carpal tunnel syndrome. Future comparative trials are required to validate these findings in a larger series. Level of Evidence  This is a Level IV study.