Endoscopic carpal tunnel release using the subligamentous two-portal technique.

The surgical treatment for entrapment neuropathy of the median nerve in the carpal tunnel is varied. Recent publications have demonstrated a closed, endoscopic method for release of the carpal tunnel using a two-portal technique. In this report, a surgical technique for performing a subligamentous modification of this two-portal procedure is discussed, and the special tools used in this approach are demonstrated. In the early portion of this series of 75 symptomatic hands in 65 patients, 8% (6/75 hands) developed transient postoperative ulnar nerve neuropraxia. One patient experienced an iatrogenic laceration of the median nerve. Following the institution of the subligamentous approach, no postoperative nerve complications occurred. The majority of the patients experienced a significant decrease in their median nerve symptoms. This procedure has been found to be safe and is equally as effective as open surgical treatment of patients with carpal tunnel syndrome.