Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy,1,2 with a lifetime incidence estimated at up to 10%.3 The pathophysiology of CTS is thought to be due to compression of the median nerve in the region of the carpal tunnel.4,5 When symptoms are recalcitrant to conservative management, surgical intervention is indicated. The goal of surgery is to decompress the median nerve in the carpal tunnel by transecting the deep transverse carpal ligament (TCL).
Surgical options include open or endoscopic division of the TCL. The gold standard of operative intervention has been the open carpal tunnel release (CTR), which was first popularized by Phalen et al.6,7 In the open technique, this division is typically carried out through a longitudinal palmar incision. Direct vision allows a safe division of the palmar fascia, following which, the TCL is identified and divided longitudinally, with care taken to protect the underlying median nerve.