Part VII: Nerve Compression

Carpal tunnel syndrome is the most common compression

neuropathy in the upper extremity. Patients failing conservative

treatment with splinting and/or corticosteroid injection often

require surgical release to alleviate the paresthesias and numb-

ness which characterize the disease. The first carpal tunnel

release was performed in 1924 by Herbert Galloway (1). Since

then, a variety of incisions have been described to visualize

the transverse carpal ligament (TCL) and avoid injury to the

underlying median nerve. Open carpal tunnel release continues

to be the gold standard for decompression of the median nerve

but reports of pillar pain and prolonged discomfort over the

palmar incision have led to the development of endoscopic

techniques. There are two main endoscopic approaches for

carpal tunnel release: single-or double-portal techniques. This

chapter reviews endoscopic carpal tunnel release through the

Mirza single-portal distal entry technique. This uniportal tech-

nique was developed after reports of injuries to anatomic

structures at the distal aspect of the TCL and allows direct

visualization of the superficial palmar arch, median nerve, and

flexor tendons (2).