chapter  36
12 Pages

Endoscopic Carpal Tunnel Release: Chow Technique

Carpal tunnel syndrome was recognized by Sir James Paget in

1854 as a median nerve compression following a fracture of the

distal radius (1,2). Later in 1880, James Putman, a neurologist

from Boston, reported the symptoms suffered by a group of his

patients (3) which would be considered as a description of a

classic carpal tunnel syndrome today. The first formal descrip-

tion of the surgical release of transverse carpal ligament for the

treatment of this pathologic condition was reported in 1933 (4)

followed by Phalen’s classic article in 1950 (5). Since that time,

open carpal tunnel release has been established as the gold

standard for the surgical treatment of carpal tunnel syndrome.

Dr. James C.Y. Chow began working on endoscopic release of

the transverse carpal ligament in 1985, unaware that both Dr.

Ichiro Okutsu in Japan and Dr. John Agee in California were

working on similar aims at approximately the same time. The

primary motivation of Dr. Chow’s concept was to create a

method for the surgical treatment of carpal tunnel syndrome

that could be able to preserve normal anatomic structures of the

wrist and hand by minimizing the surgical wound and thus,

resulting in a better clinical outcome. Through persistent trials

and different approaches, a slotted cannula was developed late

in 1986. Following several months of repetitive practice on

cadaveric hands, the procedure was completed in May 1987

and it was first performed in a patient in September of the same

year. There have been some modifications of the original

procedure since its conception.