Carpal tunnel release using limited direct vision.

A novel method to release the carpal tunnel is presented. It combines the advantages of endoscopic and open techniques while utilizing standard instruments. A lighted Killian nasal speculum is introduced between the palmar fascia and the transverse carpal ligament. The ligament is incised under direct vision. The procedure was performed in 28 cadaver hands and followed by inspection utilizing the open method through an interthenar incision. The transverse carpal ligament was completely divided in all hands without nerve or tendon injury. The superficial palmar arch was injured in one hand (3.6 percent). The advantages, disadvantages, pitfalls, and results are discussed. The technique is simple and effective, employs inexpensive instruments, and has a low complication rate.