Endoscopic carpal tunnel release.

Open carpal tunnel release has been the standard treatment of carpal tunnel syndrome for the past three decades. Since its introduction in the late 1980s, endoscopic carpal tunnel release has generated excitement and controversy. Two basic techniques have developed: the single portal and the double portal. Data from many clinical series and cadaver studies are available for review. The endoscopic carpal tunnel release offers several advantages over the standard open technique, including less scar tenderness, earlier return to work and activities of daily living, and earlier return of pinch and grip strength. Endoscopic carpal tunnel release may be safer than many of the new "mini" open techniques. The indications and threshold for surgery are the same in both techniques. The major contraindications are rheumatoid arthritis, mass lesions, and repeat surgery. Many adjunctive procedures done with open carpal tunnel release such as exploration of the motor branch, release of Guyon's canal, epineurotomy or neurolysis, and flexor tenosynovectomy are unnecessary. With proper training and equipment, endoscopic carpal tunnel release can be done safely, with complication rates comparable to those for the open technique and with high patient satisfaction.