Entrapment Neuropathy Of Median Nerve Research Articles

A comparative study on efficacy of modified endoscopic minimally invasive treatment and traditional open surgery for primary carpal tunnel syndrome

Background and ObjectiveCarpal tunnel syndrome (CTS) is the most common type of median nerve entrapment neuropathy. This study aims to comparatively assess the effectiveness and clinical efficacy of modified transforaminal endoscopic minimally invasive incision of transverse carpal ligament against traditional open incision of transverse carpal ligament in the treatment of CTS.MethodThe clinical data of 35 patients (57 wrists) with primary CTS treated in Shanxi Bethune Hospital, China, were retrospectively analyzed. The patients were divided into observation group (21 cases, 33 wrists) and control group (14 cases, 24 wrists), respectively, who underwent modified endoscopic minimally invasive incision of transverse carpal ligament and traditional open incision of transverse carpal ligament release. The Boston Carpal Tunnel Questionnaire (BCTQ) was assessed at for points: before the operation; 2 weeks; 1 month; and 3 months after operation. The BCTQ scores of the two groups were compared on all four points. The incidence of intraoperative and postoperative complication was used as the evaluation index. The study variables were comparatively assessed before and postoperation and also between the groups.ResultsThe BCTQ scores at 2 weeks, 1 month and 3 months after the operation were significantly lower than preoperative BCTQ scores (P < 0.005) for both the groups. There was no significant difference in BCTQ scores between the two groups at the four assessment points (P > 0.005). The scar size and wound healing time were significantly better with modified transforaminal endoscopic minimally invasive transverse carpal ligament incision.ConclusionThe clinical effects of both modified transforaminal minimally invasive incision of transverse carpal ligament and traditional open incision of transverse carpal ligament are significant, while the treatment efficacy of modified transforaminal minimally invasive transverse carpal ligament incision is better in terms of operation time, wound size, postoperative scar size and incision healing time.

Minimally invasive carpal tunnel release: A clinical case study and surgical technique

Carpal tunnel syndrome (CTS) is the most prevalent type of median nerve entrapment neuropathy. CTR surgery with a single limited incision is becoming more widely accepted. A better recovery, less pillar pain, less scarring, and an earlier return to work are the key benefits of single limited incision. This study provides an inquiry report on the surgical method, surgical advice, and outcomes of single limited incision minimally invasive carpal tunnel release for CTS. A 60-year-old female developed carpal tunnel syndrome (CTS). Patient received minimally invasive carpal tunnel release using single limited incision following the failure non operative treatment and the patient was able to return to work with excellent 1-year outcomes. The patient was extremely satisfied with this operative technique. This case highlights a successful outcome of a minimal invasive surgery in CTS. Visual efficiency during surgery and full transverse carpal ligament release are both improved with this technique which requires only a single limited incision. The transverse carpal ligament is totally released with this approach. During the operation, median nerves and superficial palmar arches are not injured. This technique has been shown to be effective and safe for minimal invasive surgery. This technique could be of interest to surgeons performing minimal invasive surgery who treat CTS.

Median nerve entrapment neuropathy before and early after sleeve gastrectomy in patients with diabetes mellitus: a prospective cross-sectional study

Entrapment neuropathies (EN) are common in all stages of diabetes mellitus (DM) and can be considered as a neurophysiological indicator of peripheral nerve damage and neuropathy in DM. Improved glycemic control has been observed after significant weight loss, following bariatric surgeries. Therefore, the aim of this study was to evaluate median nerve neuropathy and changes of other nerve conduction Study (NCS) parameters of the upper extremity after bariatric sleeve gastrectomy in patients with obesity and type 2 diabetes (T2D). This was a prospective cross-sectional study. Patients aged 18–58 years old with type 2 diabetes mellitus and BMI above 30 kg/m2 candidates for sleeve gastrectomy entered the study. All patients underwent a standard NCS of upper limbs including electrophysiologic study of the median and ulnar nerves before the operation and 3 months later. Fifteen patients entered the study (7 male and 8 female). Mean ± SD of BMI before and after surgery were 41.75 ± 3.90 and 33.83 ± 2.264 with a significant decrease. Severity of the median nerve entrapment neuropathy did not significantly change after the operation (0.572). Of all median and ulnar NCS parameters, nerve conduction velocity (NCV) of the right median and the left ulnar nerves significantly improved after surgery (P value = 0.004, P value = 0.009, respectively). The severity of median nerve entrapment neuropathy as a primary manifestation of diabetic neuropathy which was evaluated by electrodiagnostic study may not change early (3 months) after sleeve gastrectomy in patients with obesity and T2D. • BMI significantly changed 3 months after sleeve gastrectomy operation in patients with obesity. • Severity of median nerve neuropathy did not significantly change 3 months after sleeve gastrectomy surgery. • Most of the parameters of ulnar and median nerves did not significantly change 3 months after sleeve gastrectomy surgery.

S1 Brain Connectivity in Carpal Tunnel Syndrome Underlies Median Nerve and Functional Improvement Following Electro-Acupuncture.

Carpal Tunnel Syndrome (CTS) is a median nerve entrapment neuropathy that alters primary somatosensory cortex (S1) organization. While electro-acupuncture (EA), a form of peripheral neuromodulation, has been shown to improve clinical and neurophysiological CTS outcomes, the role of EA-evoked brain response during therapy (within and beyond S1) for improved outcomes is unknown. We investigated S1-associated whole brain fMRI connectivity during both a resting and sustained EA stimulation state in age-matched healthy controls (N = 28) and CTS patients (N = 64), at baseline and after 8 weeks of acupuncture therapy (local, distal, or sham EA). Compared to healthy controls, CTS patients at baseline showed decreased resting state functional connectivity between S1 and thalamic pulvinar nucleus. Increases in S1/pulvinar connectivity strength following verum EA therapy (combined local and distal) were correlated with improvements in median nerve velocity (r = 0.38, p = 0.035). During sustained local EA, compared to healthy controls, CTS patients demonstrated increased functional connectivity between S1 and anterior hippocampus (aHipp). Following 8 weeks of local EA therapy, S1/aHipp connectivity significantly decreased and greater decrease was associated with improvement in patients' functional status (r = 0.64, p = 0.01) and increased median nerve velocity (r = −0.62, p = 0.013). Thus, connectivity between S1 and other brain areas is also disrupted in CTS patients and may be improved following EA therapy. Furthermore, stimulus-evoked fMRI connectivity adds therapy-specific, mechanistic insight to more common resting state connectivity approaches. Specifically, local EA modulates S1 connectivity to sensory and affective processing regions, linked to patient function and median nerve health.

Combination of Telerehabilitation with Conventional Therapy in the Treatment of Bilateral Carpal Tunnel Syndrome: A Case Report

Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy of median nerve. The current development of global COVID-19 pandemic urges medical rehabilitation services to deliver a comprehensive approach amidst the physical distancing period. This case report aims to investigate the feasibility and efficacy of implementing telerehabilitation to the conventional therapy in the treatment of CTS. A 51-year old female presented with post carpal tunnel release of the left hand, and chronic-severe CTS on right hand. We maintained 5 weeks rehabilitation programs of combined telerehabilitation and face-to-face rehabilitation therapy and evaluation. The patient showed good compliance with the programs and achieved the intended goals within 5 weeks of therapy. Patient showed improvement (in pain, range of motions, hand functions, and ADLs). Telerehabilitation combined with conventional therapy were effective and feasible in treating patient with bilateral (left post-release and right chronic-severe) CTS. The use of telerehabilitation may add accessibility while reducing physical contact in order to minimize the risk of transmission of COVID-19.

Median nerve entrapment neuropathy at the elbow by mild haemophilia; A case of bicipital aponeurosis syndrome

Median nerve entrapment neuropathy at the elbow by mild haemophilia; A case of bicipital aponeurosis syndrome

Effects of Neural Mobilization on Electrophysiological Measures-A Quasi Experimental Design

The objective of the study was to identify effects of neural mobilization on electrophysiological measures of nerve (latency, velocity and amplitude) during and after neural mobilization in normal healthy individuals having normal neurodynamics and in patients diagnosed with median nerve entrapment neuropathy around the wrist joint (in altered neurodynamics of peripheral nerves). 30 normal healthy individuals and 30 patients with entrapment neuropathy of median nerve around the wrist joint were taken in the study. Pre neural mobilization, Motor and sensory nerve conduction studies of median nerve were performed and electrophysiological measures like distal latency, amplitude and velocity were taken. Median nerve mobilization-ULTT 2 was performed on participants. During neural mobilization and after neural mobilization (immediate after neural mobilization, after 10 minutes and 30 minutes) electrophysiological measures of median nerve were taken again. The results of the study shows that neural mobilization has no significant effects on all electrophysiological measures of nerve during and after neural mobilization in normal healthy individuals having normal neurodynamics and in patients diagnosed with median entrapment neuropathy around the wrist joint. Hypothesized effects of neural mobilization, in promoting physiological functions of nerve, have no effects in promoting electrophysiological measures of nerve.

Study of Wrist Ratio and Wrist-to-Palm Index Radio in Individuals Suffering from Carpal Tunnel Syndrome.

Background:Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy, with preponderance in females.Aims and Objective:The aim of the present study was to find out wrist ratio (WR) and wrist/palm ratio (WPR) in clinically diagnosed patients of CTS.Methodology:One hundred individuals (fifty patients of CTS and fifty as control group) aged between 30 and 50 years were recruited for the study. Early confirmation of clinically suspected patients of CTS was done by performing electrodiagnostic tests of median and ulnar nerves. Motor and sensory conduction velocities, distal motor and sensory latencies, and F-wave latencies were performed in the recruited volunteers.Results:The values for mean wrist ratio in control groups were 0.694, 0.703 respectively, and in patients with carpal tunnel syndrome, it was 0.704 and 0.719 respectively in moderate and severe type. The mean wrist to palm ratio (WPR) in control group was 0.371, while in patients with CTS, it was 0.374, 0.382, 0.387, and 0.401 based on progression of severity. Both were statistically significant for the last two groups (wrist to index finger [WIF] >4.4 m/s, moderate, and WIF nonrecordable, severe). Statistically significant (P < 0.001) decrease of motor conduction velocities for median nerve was seen in the CTS group as compared to control group. Statistically significant (P < 0.001) increase in distal motor and sensory latencies was observed for both median and ulnar nerves in CTS group with more increase in distal motor latency than sensory latency. Increase in F-wave latencies of both nerves was seen in CTS group.Conclusion:The study results confirm selective slowing of sensory and motor conduction within wrist-to-palm segment in patients of CTS. Both WR and WPR have a progressive correlation with the severity of CTS, but statistically significant changes were seen in the groups with moderate and severe CTS. Thus, WR/WPR can act as one of the essential parameters in the diagnosis of CTS with moderate-to-severe CTS.

Electrophysiological and functional outcome after carpal tunnel release in patients with carpal tunnel syndrome: A prospective evaluation

Background: The Carpal tunnel syndrome (CTS) is median nerve entrapment neuropathy at wrist and is one of the commonly diagnosed disabling condition of the upper extremity. The only scientifically established disease modifying treatment is carpal tunnel release (CTR). Electrophysiological study helps in detecting and aiding in the diagnosis of CTS and helps in determining level of improvement after release. Material and Methods: Two year Prospective Study conducted in Tata Main Hospital, Jamshedpur on 33 cases of carpal tunnel syndrome. All patients underwent open carpel tunnel release. Electrophysiological and functional outcome was assessed using Nerve Conduction Study (NCS) and Boston Carpal Tunnel Questionnaire (BCTQ) both preoperatively and at 1 month, 3 months and 6 months postoperatively. Results: The CTS was most common in age group 40-50 years. Females were more affected with the ratio of 7:1. Mean BCTQ score preoperatively was 2.9. Post-operative at 1 month it showed marked improvement in mean score to 1.83. At 3 and 6 month follow up it reduced to 1.58 and 1.51 respectively. NCS were assessed using mean values of Nerve sensory latency (NSL), Nerve Motor Latency (NML), Nerve Sensory Velocity (NSV), and Nerve Motor Velocity (NMV). Preoperative evaluation shows higher latency (NSL 5.23±0.88, NML 5.23±0.63) and lower velocity (NSV 30.12±3.09, NMV 30.28±4.30). Both of which improved following CTR with mean NSL 4.46±0.59, NML 4.72±0.47, NSV 39.55±1.93, and NMV 36.55±5.32 at 1 month. Further follow up at 3 and 6 month also showed significant improvement. Conclusions: Boston Carpal Tunnel Questionnaire is good tool to evaluate functional outcome after carpal tunnel release. Nerve Conduction Studies serve as a valuable tool to assess follow up as it can provide reassurance to the patient that their operation is successful and that there is further potential for clinical improvement.

Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle

ABSTRACT An unusual bilateral variation of lateral root of median nerve piercing through coracobrachialis muscle is presented. Two nerve filaments to coracobrachialis muscle took unusual origin from medial cord, which crossed the axillary artery from medial to lateral side before entering the muscle. Variation of lateral root of median nerve may be clinically significant, as hitherto unreported entrapment neuropathy of median nerve along with musculocutaneous may occur at the arm level while passing through coracobrachialis muscle or it may be injured during any surgical intervention around shoulder joint. Nerves to coracobrachialis are at risk during unusual abduction of arm or surgical manipulation of axillary artery. How to cite this article Aggarwal A, Gupta T, Aggarwal A, Sahni D. Bilateral Variation of Lateral Root of Median Nerve traversing through Coracobrachialis Muscle. J Postgrad Med Edu Res 2016;50(3):159-161.

A study of median nerve entrapment neuropathy at wrist in uremic patients.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy seen in uremic patients. The study was undertaken to estimate the frequency of CTS in uremic patients and to identify the most sensitive electrodiagnostic test. Study was conducted on 80 subjects of age 30–60 years. End-stage kidney disease patients were recruited for the clinical evaluation, motor nerve conduction studies (NCS), sensory NCS, F wave study and median-versus-ulnar comparison studies (palm-to-wrist mixed comparison study, digit 4 sensory latencies study and lumbrical-interossei comparison study). Among three different diagnostic modalities, frequency of CTS was found to be 17.5% with clinical evaluation, 15% with routine NCS studies and 25% with median-versus-ulnar comparison studies. Among the median-versus-ulnar comparison studies, lumbrical-interossei comparison study was found to be most sensitive (90%). The comparative tests for CTS are more sensitive compared to routine NCS and clinical examination. Among the comparative tests, lumbrical-interossei comparison study is the most sensitive. Early diagnosis of CTS may help patients of uremia to seek proper treatment at an appropriate time.

Functional deficits in carpal tunnel syndrome reflect reorganization of primary somatosensory cortex.

Carpal tunnel syndrome, a median nerve entrapment neuropathy, is characterized by sensorimotor deficits. Recent reports have shown that this syndrome is also characterized by functional and structural neuroplasticity in the primary somatosensory cortex of the brain. However, the linkage between this neuroplasticity and the functional deficits in carpal tunnel syndrome is unknown. Sixty-three subjects with carpal tunnel syndrome aged 20-60 years and 28 age- and sex-matched healthy control subjects were evaluated with event-related functional magnetic resonance imaging at 3 T while vibrotactile stimulation was delivered to median nerve innervated (second and third) and ulnar nerve innervated (fifth) digits. For each subject, the interdigit cortical separation distance for each digit's contralateral primary somatosensory cortex representation was assessed. We also evaluated fine motor skill performance using a previously validated psychomotor performance test (maximum voluntary contraction and visuomotor pinch/release testing) and tactile discrimination capacity using a four-finger forced choice response test. These biobehavioural and clinical metrics were evaluated and correlated with the second/third interdigit cortical separation distance. Compared with healthy control subjects, subjects with carpal tunnel syndrome demonstrated reduced second/third interdigit cortical separation distance (P < 0.05) in contralateral primary somatosensory cortex, corroborating our previous preliminary multi-modal neuroimaging findings. For psychomotor performance testing, subjects with carpal tunnel syndrome demonstrated reduced maximum voluntary contraction pinch strength (P < 0.01) and a reduced number of pinch/release cycles per second (P < 0.05). Additionally, for four-finger forced-choice testing, subjects with carpal tunnel syndrome demonstrated greater response time (P < 0.05), and reduced sensory discrimination accuracy (P < 0.001) for median nerve, but not ulnar nerve, innervated digits. Moreover, the second/third interdigit cortical separation distance was negatively correlated with paraesthesia severity (r = -0.31, P < 0.05), and number of pinch/release cycles (r = -0.31, P < 0.05), and positively correlated with the second and third digit sensory discrimination accuracy (r = 0.50, P < 0.05). Therefore, reduced second/third interdigit cortical separation distance in contralateral primary somatosensory cortex was associated with worse symptomatology (particularly paraesthesia), reduced fine motor skill performance, and worse sensory discrimination accuracy for median nerve innervated digits. In conclusion, primary somatosensory cortex neuroplasticity for median nerve innervated digits in carpal tunnel syndrome is indeed maladaptive and underlies the functional deficits seen in these patients.

Median nerve entrapment neuropathy at the wrist : Splinting for carpal tunnel syndrome

Median nerve entrapment neuropathy at the wrist : Splinting for carpal tunnel syndrome

Utility of nerve conduction study in early diagnosis of carpal tunnel syndrome (CTS)

Background: Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy with preponderance in females. Aims & Objective: The present study was carried out for early conformation of clinically diagnosed patients of Carpal Tunnel Syndrome (CTS) by electrodiagnostic tests which include motor conduction, sensory conduction, and F-wave studies. Materials and Methods: Early confirmation of clinically suspected patients of CTS by performing electrodiagnostic tests of median and ulnar nerves. 100 subjects of age group 30-50 years (50 clinically suspected patients of CTS, 50 as control group) were studied. Motor and Sensory conduction velocities, distal motor and sensory latencies and F wave latencies were performed using Medtronic Keypoint@ 2 EMG EP software. Results: Statistically significant (P

Altered brain morphometry in carpal tunnel syndrome is associated with median nerve pathology

ObjectiveCarpal tunnel syndrome (CTS) is a common median nerve entrapment neuropathy characterized by pain, paresthesias, diminished peripheral nerve conduction velocity (NCV) and maladaptive functional brain neuroplasticity. We evaluated structural reorganization in brain gray matter (GM) and white matter (WM) and whether such plasticity is linked to altered median nerve function in CTS.MethodsWe performed NCV testing, T1-weighted structural MRI, and diffusion tensor imaging (DTI) in 28 CTS and 28 age-matched healthy controls (HC). Voxel-based morphometry (VBM) contrasted regional GM volume for CTS versus HC. Significant clusters were correlated with clinical metrics and served as seeds to define associated WM tracts using DTI data and probabilistic tractography. Within these WM tracts, fractional anisotropy (FA), axial (AD) and radial (RD) diffusivity were evaluated for group differences and correlations with clinical metrics.ResultsFor CTS subjects, GM volume was significantly reduced in contralesional S1 (hand-area), pulvinar and frontal pole. GM volume in contralesional S1 correlated with median NCV. NCV was also correlated with RD and was negatively correlated with FA within U-fiber cortico-cortical association tracts identified from the contralesional S1 VBM seed.ConclusionsOur study identified clear morphometric changes in the CTS brain. This central morphometric change is likely secondary to peripheral nerve pathology and altered somatosensory afference. Enhanced axonal coherence and myelination within cortico-cortical tracts connecting primary somatosensory and motor areas may accompany peripheral nerve deafferentation. As structural plasticity was correlated with NCV and not symptomatology, the former may be a better determinant of appropriate clinical intervention for CTS, including surgery.

PA01.49.Carpal tunnel syndrome: A case report

Purpose: Carpal tunnel syndrome is an entrapment neuropathy of median nerve causing paraesthesia, pain, numbness and other symptoms in the distribution of median nerve due to its compression at wrist in carpal tunnel. Modern medicine prescribes surgery for its treatment. We report a case that was treated completely without any recurrence. Method: Case presentation: A female patient aged 23 years presented with numbness in the middle finger of left hand associated with paraesthesia, morning stiffness, loss of delicate movements of middle finger and dropping of small objects since 4 days. She consulted an allopathic doctor and was diagnosed as having Carpal tunnel syndrome (CTS). She was advised surgery. The patient was reluctant for undergoing surgery and took the medicines for 1 day, but had no relief. Next day she came to the OPD. On examination, Tinel™s percussion test and hand diagram were positive. On assessment, symptom severity scale (SSS) and functional status scale (FSS) were found to be 1.5 and 3.5 respectively, before treatment. Treatment given was varanadi kashaya, sahacharadi and supti taila, yogaraja guggulu, cap chelnar, dhanyamla dhara, shunthibaladi choorna etc, for a period of 1 month. The medicines were changed as per the condition of patient and the disease, at every follow up of 1 week, during the 1 month of treatment. Result: At the end of 1 month patient got complete relief from her complaints, and the scales SSS and FSS scored 0. Conclusion: The treatment given here aimed at release of compression by considering the involvement of doshas. The state of the disease was acute due to which complete relief was achieved. Thus if patients come to Ayurveda in early stages of the disease, prognosis will be better.

Pulse Wave Velocity and Electroneurophysiological Evaluation in patients of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic systemic inflammatory disease ofundetermined etiology involving the synovial membranes and articular structures of multiple joints and is also associated with carditis, pleuritis, hepatitis, peripheral neuropathy and vasculitis. The present study was undertaken to investigate arterial stiffness using carotid-radial and femoral-dorsalis pedis pulse wave velocity measurements andelectrophysiological tests for peripheral nervous system involvement. 25 patients (aged between 20-60 years) with rheumatoid arthritis according to the criteria of the American College of Rheumatology and 25 control subjects of the same age and sex were recruited. In the motor conduction studies, out of 25 patients of Rheumatoid arthritis, 6 had clinicalevidence of peripheral neuropathy. 11 patients showed pure sensory neuropathy (44%), 10 showed mixed sensory motor neuropathy (40%) while 4 showed normal motor and sensory conduction velocity. Two patients (8%) showed features of entrapment neuropathy of median nerve i.e. feature of Carpal tunnel syndrome. In the pulse wave velocity evaluationstatistically significant increase in pulse wave velocity between femoral-dorsalis pedis and carotid-radial artery segments was observed in Rheumatoid arthritis patients as compared to the control group. Measurement of carotid-radial and femoral-dorsalis pedis PWV mayprovide a simple and non-invasive technique for identifying patients at increased risk of vascular disease in Rheumatoid arthritis.

Correlation of median forearm conduction velocity with carpal tunnel syndrome severity

Objective Median nerve entrapment neuropathy at the wrist can be accompanied by slowed motor conduction within the forearm. Existing studies conflict regarding a correlation between the severity of the entrapment neuropathy in carpal tunnel syndrome (CTS) and slowing of median motor nerve conduction velocity (MNCV) in the forearm. Here, it was asked if there is a correlation between markers of CTS severity and median forearm MNCV, and if there is an explanation for the preceding conflicting results. Methods Median MNCV in the forearm was correlated with neurophysiologic markers of severity of a median neuropathy at the wrist in 91 hands from 64 patients with clinical and electrodiagnostic evidence of CTS. Results Median MNCV within the forearm segment was negatively correlated with the median nerve distal motor latency ( r = −0.64, P < 0.001, n = 91) and positively correlated with the CMAP amplitude of the abductor pollicis brevis muscle ( r = 0.45, P < 0.001, n = 91). These correlations only occurred in patients with a prolonged median distal motor latency. Previous investigations that failed to find such correlations used variable or non-standardized methods or analyzed smaller numbers of patients. Conclusions Slowing of median MNCV in the forearm is related to the severity of the entrapment of median motor fibers at the wrist. Significance Slowed forearm median MNCV can be a marker of motor nerve injury at the wrist.

Synovial osteochondromatosis at the elbow producing ulnar and median nerve palsy: Case report and review of the literature

The authors present the case of a 53-year-old woman suffering from synovial osteochondromatosis of her right elbow responsible for ulnar and median nerve entrapment neuropathy. This condition is characterised by the formation of multiple cartilaginous nodules in the metaplastic synovium of otherwise normal joints, bursae or tendon sheaths. Treatment consisted of partial synovectomy, removal of loose bodies and microscopic nerve release. Synovial osteochondromatosis complicated by nerve compression syndromes has been rarely reported, usually with ulnar tunnel syndrome at the elbow. The literature on this subject is reviewed.

Two-portal endoscopic carpal tunnel release surgery: report of early experience.

Endoscopic carpal tunnel release is increasingly performed to treat median nerve entrapment neuropathy at the transverse carpal ligament. Proponents of these procedures claim that there are early postoperative advantages to be gained by the patient in the form of decreased pain and weakness, thus facilitating an earlier return to function. However, serious complications associated with the use of these techniques have been reported, especially during the surgeon's purported initial steep learning curve. A prospective analysis of the authors' first 51 cases using a two-portal endoscopic technique was conducted to determine whether these learning curve complications occurred. The authors did experience a learning curve; however, it was not significant. They encountered no serious complications and patient satisfaction was very high. It is concluded that the procedure is relatively easy to learn and safe to perform.