Patent Publication Number: US-2015073461-A1

Title: Systems and methods for treatment of compressed nerves

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation application of Ser. No. 13/170,112 filed Jun. 27, 2011, entitled “Systems and Methods for Treatment of Compressed Nerves,” which is a continuation-in-part of Ser. No. 12/852,348 filed on Aug. 6, 2010, entitled “Systems and Methods for Treatment of Compressed Nerves,” now U.S. Pat. No. 8,348,966; and which claims priority to U.S. provisional patent application No. 61/266,903, filed on Dec. 4, 2009, entitled “Systems and Methods for Treatment of Carpal Tunnel Syndrome and Plantar Fasciitis” and U.S. provisional patent application No. 61/232,325, filed on Aug. 7, 2009, entitled “Systems and Methods for Treatment of Carpal Tunnel Syndrome.” The full disclosure the above-listed patent application is hereby incorporated by reference herein. 
    
    
     FIELD OF THE INVENTION 
     The present disclosure relates to systems and methods for treatment of compressed nerves. 
     BACKGROUND 
     Carpal tunnel syndrome (CTS) is a painful condition of the hand characterized by tingling and numbness and loss of grip strength. CTS is caused by the compression of the median nerve at the carpal tunnel and it is one of the common nerve entrapment syndromes. 
     As shown in  FIG. 1 , which illustrates a normal or non-compressed carpal tunnel, the carpal tunnel  5  is the area of the wrist and palm of the hand  10  formed by a U-shaped cluster of bones  15  that form a hard floor and two walls of the tunnel  5 . The roof of the tunnel is formed by the transverse carpal ligament (TCL)  20  which attaches to the wrist bones. Within the confines of the tunnel  5  is the median nerve  25  and the flexor tendons  30  of the thumb and fingers. 
     As indicated in  FIG. 2 , which depicts a compressed carpal tunnel, a thickening of the TCL  20  and a corresponding narrowing of the size of the carpal tunnel  5  may precipitate CTS. This thickening causes compression of the flexor tendons  30  and median nerve  25  which leads to CTS symptoms. 
     A number of factors may contribute to the thickening of the TCL. Normal wear and tear and repetitive wrist movements may cause thickening of the TCL. Wrist fracture may cause bony narrowing of the tunnel. Pregnancy, obesity, diabetes, thyroid dysfunction and chronic renal failure may predispose a patient to CTS. CTS generally occurs in people between the ages of 30 and 60 and it is more common in females. 
     Diagnosis of CTS may be established by history and examination. Symptoms may include nocturnal hand pain. Positive examination findings include nerve irritation signs, such as positive Phalen&#39;s wrist flexion test, and Tinel&#39;s sign, and weakness and numbness in the median nerve distribution. Electrical studies show prolongation of about 3.5 milliseconds is present in many surgically confirmed cases. 
     Medical management may be by splinting, anti-inflammatories, and steroid injections in the wrist. If unsuccessful, surgical intervention to decompress or release the TCL may be indicated. 
       FIG. 3  depicts one type of surgical technique, known as an open release surgery. Open surgical decompression by cutting the TCL was first described in 1930 by Learmonth. The open technique involves creation of an incision beginning in the palm and extending to the wrist. Through this open incision, a surgeon may directly visualize the TCL and may use a scalpel to cut completely through the TCL and release the compression of the median nerve. Angling the incision towards the ulnar aspect of the wrist helps to avoid cutting the palmar sensory cutaneous branch of the median nerve. The skin incision can vary in length from one to five inches depending upon training and experience but should be sufficient to allow full sectioning of the TCL. 
     After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. Patients may be directed to wear a splint for several weeks. The pain and numbness may go away right after surgery or may take several months to subside. 
     However, open incisions require significant time to heal. Also, the skin in the palm is thick and prone to cracking and hand immobilization is necessary for wound healing. Patients are often advised to avoid heavy use of their hand for up to 3 months. When a patient&#39;s return to work is dependent on the operated hand, rehabilitative physical therapy is commonly prescribed. Therapy is often prescribed for the resultant symptomatic scar tissue. 
       FIG. 4  depicts another type of surgical technique known as an endoscopic release surgery. Endoscopic carpal tunnel release is a technical procedure that requires microscopic techniques and the correct endoscopic equipment with the necessary back up equipment. 
     To perform the procedure, anesthetic is administered and an incision is marked out on the wrist just proximal to the palm. The superficial tendon and small veins are retracted to prevent nerve injury. An ‘L’ or ‘U’ shaped incision is made in the first layer called the flexor retinaculum. This layer is lifted up as a flap that forms a doorway into the carpal tunnel. 
     A spoon shaped device (such as a synovial elevatoris) is used to clean the under surface of the ligament to provide visualization with an endoscope. Dilators help to compress the tissues in the carpal canal to make it possible to insert the endoscopic device with minimal pressure. The endoscopic device is inserted carefully so that the ligament can be seen along its entire length. Often the device is warmed to prevent fogging. Once the ligament is clearly seen, the small blade in the device is used to release the ligament in stages, after making sure that important nerves and arteries are protected. 
     Once the ligament is completely released, the rest of the flexor retinaculum in the wrist is released with a special type of scissors. Local anesthetic is injected for post-operative pain relief and the incision is sutured. A soft bandage is applied for the patient to keep on for two days to reduce swelling. After two days they can remove the larger dressing and apply a Band-Aid. 
     This method requires specialized training and a long learning curve. Surgery is longer than the open release procedures and significant injuries have been reported. 
     Plantar fasciitis is a painful inflammatory process of the plantar fascia. The plantar fascia is a thick fibrous band of tissue originating at the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. According to one study, plantar fasciitis occurs in two million Americans a year and will occur in 10% of the population over a lifetime. Plantar fasciitis is commonly associated with long periods of work-related weight bearing activity, and among non-athletic populations, it is associated with a high body mass index. Typically, pain is felt on the underside of the heel and one may suffer from decreased dorsiflexion of the ankle in addition to knee pain. Generally, treatment is non-surgical, although surgical treatment may be used. One type of surgical technique may include use of an ultrasound guided needle. The needle is inserted into the plantar fascia and moved back and forth to disrupt the fibrous tissue. Another surgical technique is a coblation surgery (also known as a Topaz procedure). This technique has been used in the treatment of recalcitrant plantar fasciitis and utilizes radiofrequency ablation. 
     However, known surgical techniques may cause injury to the nerve, infection and may fail to relieve the pain. 
     There is a need in the art for improved systems and methods for surgical treatment of carpal tunnel syndrome and plantar fasciitis with increased efficiency and reduced surgical complications. 
     BRIEF SUMMARY 
     Disclosed herein is a system for releasing the transverse carpal ligament to decompress the median nerve. In one embodiment, the system includes an introducer, an elongated body including a blunt tip and a cutting member for cutting the transverse carpal ligament to decompress the median nerve, a neuro-monitoring system operably connected to the elongated body for aiding a surgeon in navigating the elongated body under the transverse carpal ligament, and handle members respectively operably attached to a distal end and a proximal end of the elongated body, wherein the handle members are operably attached to the respective distal and proximal ends of the elongated body after the elongated body is navigated under the transverse carpal ligament and wherein the handle members at the distal end and the proximal end of the elongated body are used to guide the cutting member of the elongated body to release the transverse carpal ligament to decompress the median nerve. In one embodiment, the system may further include a hand immobilizing system. 
     Disclosed herein is a method for releasing the transverse carpal ligament to decompress the median nerve. In one embodiment, the method includes providing an introducer into the deep wrist of a patient&#39;s hand, introducing an elongated body into the introducer, the elongated body including a blunt tip, a cutting member, a distal end and a proximal end, providing a neuro-monitoring system operably attached to the elongated body, navigating the elongated body under the transverse carpal ligament to an exit point at a surface of the patient&#39;s hand via input received from the neuro-monitoring system, extending at least a portion of the elongated body through the exit point such that the distal end of the elongated body is external to the hand, removing the introducer, providing handle members and operably attaching one handle member to the distal end and another handle member to the proximal end of the elongated body, and using the handle members to displace the cutting member of the elongated body along the transverse carpal ligament to release the transverse carpal ligament thereby decompressing the median nerve. In one embodiment, the method may further include providing a hand immobilizer system to immobilize the patient&#39;s hand while using the handle members to displace the cutting member of the elongated body along the transverse carpal ligament to release the transverse carpal ligament thereby decompressing the median nerve. 
     Disclosed herein is a system for releasing the transverse carpal ligament to decompress the median nerve. In one embodiment the system includes an introducer, a first elongated body including a blunt tip and a cutting member for cutting the transverse carpal ligament to decompress the median nerve, a second elongated body including a proximal end and a distal end having a hook, a neuro-monitoring system operably connected to the elongated body for aiding a surgeon in navigating the elongated body under the transverse carpal tunnel ligament; and handle members respectively operably attached to a distal and proximal end of the first elongated body, wherein the handle members are operably attached to the respective proximal and distal ends of the first elongated body after the first elongated body is navigated under the transverse carpal ligament and the second elongated body is navigated through subcutaneous tissue above the transverse carpal ligament and the second elongated body is operably attached to the first elongated body such that when the second elongated body is withdrawn, the first elongated body creates a loop structure about the transverse carpal ligament and wherein the handle members at the distal end and the proximal end of the first elongated body are used to guide the cutting member of the first elongated body to release the transverse carpal ligament to decompress the median nerve. 
     Disclosed herein is a system for releasing the plantar fascia to treat plantar fasciitis in a plantar fascia release procedure. In one embodiment, the system may include an introducer, an elongated body including a blunt tip and a cutting member for cutting the plantar fascia in a plantar fascia release procedure, a neuro-monitoring system operably connected to the elongated body for aiding a surgeon in navigating the elongated body under the plantar fascia, and handle members respectively operably attached to a distal and proximal end of the elongated body, wherein the handle members are operably attached to the respective proximal and distal ends of the elongated body after the elongated body is navigated under the plantar fascia and wherein the handle members at the distal end and the proximal end of the elongated body are used to guide the cutting member of the elongated body to release the plantar fascia to treat plantar fasciitis in a plantar fascia release procedure. 
     Disclosed herein is a system for releasing the transverse carpal ligament to decompress the median nerve. In one embodiment, the system includes an elongated body including a blunt tip and a cutting member for cutting the transverse carpal ligament to decompress the median nerve, a neuro-monitoring system operably connected to the elongated body for aiding a surgeon in navigating the elongated body under the transverse carpal tunnel ligament, a securing member that is operably attached to a distal end of the cutting member after the elongated body is navigated under the transverse carpal ligament and the cutting member exits a distal end of the elongated body and then exits the hand at an exit point in the palm, and a handle member including an actuator operably attached to a proximal end of the elongated body wherein the actuator of handle member at the proximal end of the elongated body is used to guide the cutting member of the elongated body to release the transverse carpal ligament to decompress the median nerve. 
     Disclosed herein is a system for releasing the transverse carpal tunnel ligament to decompress the median nerve. In one embodiment, the system includes an introducer, an elongated body including a proximal end and a distal end, a blunt tip and a cutting member for cutting the transverse carpal ligament to decompress the median nerve, a neuro-monitoring system operably connected to the elongated body for aiding a surgeon in navigating the elongated body under the transverse carpal tunnel ligament, a piercing member that is operably attached to a distal end of the cutting member to pierce the palm at an exit point in the palm of the hand as the cutting member exits the distal end of the elongated body and then exits the hand at the exit point in the palm, a motion limiting feature operably connected to the proximal end of the elongated body, the motion limiting feature configured to prevent the introducer from re-entering an entry point in the palm after withdrawal and configured to prevent the elongated body from exiting at the exit point in the palm, a first handle member operably attached to a proximal end of the elongated body, and a second handle member operably attached to the piercing member at the distal end of the cutting member after the piercing member and the cutting member exit the palm of the hand, wherein the first and second handle members are used to guide the cutting member of the elongated body to release the transverse carpal ligament to decompress the median nerve. In some embodiments, the first handle member may further include an actuator. In some embodiments, this system may be used to release the plantar fascia to treat plantar fasciitis. 
     Disclosed herein is a system for releasing a ligament. In one embodiment, the system includes a proximal handle, a tubular body, and a flexible body. The tubular body includes a proximal end and a distal end. The handle is coupled to the proximal end. The flexible body extends through the tubular body and includes a tissue cutting portion. The flexible body is longitudinally displaceable relative to the tubular body to move the tissue cutting portion between a non-deployed state and a deployed state. 
     In one version of the embodiment, the tissue cutting portion includes a plurality of teeth or an abrasive surface. In another version of the embodiment, the tissue cutting portion includes an RF energy cutter or a water jet. 
     In one version of the embodiment, the flexible body is longitudinally displaced relative to the tubular body during a tissue cutting motion. In another version of the embodiment, the flexible body and tubular body are moved together during a tissue cutting motion. In yet another version of the embodiment, the flexible body is axially rotationally displaced relative to the tubular body during a tissue cutting motion. 
     In another version of the embodiment, the tubular body is longitudinally displaced relative to the flexible body to expose the tissue cutting portion of the flexible body. In one version of the embodiment, the longitudinal displacement of the tubular body is displaced through one or more actuators on a handle member attached to the proximal end of the tubular body. In one version of this embodiment, the actuator utilizes a spring device to retract the tubular body. In another version of this embodiment, the actuator rotates to retract the tubular body. In yet another version of this embodiment, the handle member includes a plurality of actuators for coinciding longitudinal displacement of the tubular body and the flexible body. In still another version of this embodiment, the tubular body includes a curved portion at the distal end. The flexible body includes a curved bias opposing the curved portion of the tubular body such that, when in the deployed state, the flexible body curves away from the curved portion of the tubular body. 
     In one version of the embodiment, the tubular body further includes a window, wherein, when the flexible body is longitudinally displaced relative to the tubular body to move the tissue cutting portion from the non-deployed state to the deployed state, the cutting portion moves from being generally hidden within the tubular body to being generally exposed in the window. 
     In another version of the embodiment, the tubular body further includes a window, wherein, when the flexible body is longitudinally displaced relative to the tubular body to move the tissue cutting portion from the non-deployed state to the deployed state, the cutting portion moves from being generally recessed within the tubular body to being generally exposed in the window. For example, in such a version, when the cutting portion is in the deployed state, the cutting portion assumes a bow-like arrangement with the tubular body. In another version of the embodiment, the window is appropriately sized to allow a hook blade tooth to be exposed within the window in the deployed state. The hook blade tooth is curved such that, when the flexible body is moved into the non-deployed state, the hook blade tooth is generally recessed within the tubular body. 
     In one version of the embodiment, the system further includes an actuator near the proximal end of the tubular body that causes the cutting portion to move between the non-deployed state and the non-deployed state. The handle may include the actuator. 
     In another version of the embodiment, the tubular body includes a hinged flap that opens to expose a tissue cutting portion of the flexible body. The hinged flap is opened through an actuator on a handle member attached to the tubular body at the proximate end. In another version of the embodiment, the tubular body includes an inner tube with an inner window and an outer tube with an outer window. The inner tube and the outer tube rotate in opposing directions into a position wherein the inner window and the outer window align. Alignment of the inner window and the outer window coincides with a deployed state such that the tissue cutting portion of the flexible body is exposed for cutting of the tissue. The rotation of the inner tube and the outer tube of the tubular body is engaged by one or more actuators on a handle member attached to the tubular body at the proximate end. 
     In one version of the embodiment, the system further includes a distal handle configured to operably couple to the distal end of the tubular body. The flexible body may further include a distal end including a tissue penetration tip that moves from a recessed state to a tissue penetration state when the flexible body is longitudinally displace relative to the tubular body. When the penetration tip is in the recessed state, the tissue cutting portion is in the non-deployed state. When the penetration tip is in the tissue penetration state, the tissue cutting portion is in the deployed state. In some versions, the distal handle is configured to operably couple to the distal end of the tubular body by being directly connected to the distal end of the flexible body when the penetration tip is in the penetration state. 
     In one version of the embodiment, the system further includes an adjustable lock supported on the tubular body that limits a distal cutting stroke displacement of the system. The distal cutting stroke displacement of the system may be limited by the adjustable lock such that the tubular body will extend through an exit hole created in the palm by the penetration tip. 
     In one version of the embodiment, the system further includes a nerve sensing system electrically coupled to the tubular body or flexible body. The nerve sensing system may be configured to sense nerve impulses or action potentials. The nerve sensing system may include an ultrasound probe operably coupled to the tubular body. The nerve sensing system may include a hardness sensor operably coupled to the tubular body. 
     Also disclosed herein is a method of releasing a ligament. In one embodiment, the method includes: percutaneously penetrating at a first location with a tubular body; positioning the tubular body adjacent the ligament; employing a nerve sensing system to position a tissue cutting portion away from a nerve, the tissue cutting portion being part of a flexible body longitudinally displaceable relative to the tubular body between a non-deployed state and a deployed state of the tissue cutting portion; causing the tissue cutting portion to longitudinally displace from the non-deployed state to the deployed state; and releasing the ligament with the tissue cutting portion. 
     Disclosed herein is a system for releasing a ligament. In one embodiment, the system includes: an introducer including a distal end and a proximal end; a flexible body including a first end, a second end and a length extending between the first end and the second end, the length forming a loop distally extending from the distal end of the introducer and configured to have the ligament in the loop, the length comprising a tissue cutting portion, the first end and the second end proximally extending from the proximal end of the introducer. The tissue cutting portion may include a plurality of teeth or an abrasive surface. 
     In one version of the embodiment, the system further includes an elongated body configured to be extended through the introducer proximal to distal and engage the first end and pull the first end around the ligament and through the introducer to form the loop such that the first end is adjacent the second end extending proximally from the proximal end of the introducer, the elongated body including a first engagement feature configured to engage a second engagement feature on the first end. The first engagement feature may include a hook and the second engagement feature may include a ball. The elongated body may include forceps. 
     In one version of the embodiment, the system further includes a first handle operably coupled to the first end and a second handle operably coupled to the second end. 
     In one version of the embodiment, the system further includes a nerve detection system coupled to the flexible body. 
     Disclosed herein is an apparatus for releasing a ligament. In one embodiment, the apparatus includes a proximal handle, a tubular handle, and an inner body. The tubular body includes a proximal end and a distal end. The handle is coupled to the proximal end. The inner body extends through the tubular body and includes a tissue cutting portion. A flap on the tubular body is transversely displaceable relative to the tubular body to expose the tissue cutting portion. 
     Another apparatus for releasing a ligament is also disclosed herein. In one embodiment, the apparatus includes a proximal handle, a tubular body, and an inner body. The tubular body includes a proximal end and a distal end. The handle is coupled to the proximal end. The inner body extends through the tubular body and includes a tissue cutting portion. At least one of: the tubular body is axially rotationally displaced relative to the inner body; or the inner body is axially rotationally displaced relative to the tubular body to transition the tissue cutting portion between a non-deployed state and a deployed state. 
     Also disclosed herein is a system for releasing a ligament. In one embodiment, the system includes a proximal handle, a tubular body and an inner body. The tubular includes a proximal end and a distal end. The handle is coupled to the proximal end. The inner body extends through the tubular body and includes a tissue cutting portion. A distal region of the inner body, when retracted within the tubular body such that the tissue cutting portion is hidden within the tubular body, has a first shape generally the same as the shape of the a distal region of the tubular body. The distal region of the inner body, when extended distally out of the tubular body such that the tissue cutting portion is outside the tubular body, has a second shape different from the first shape. 
     Yet another system for releasing a ligament is disclosed herein. In one embodiment, the system includes a tubular body and an inner body. The tubular body includes a proximal end and a distal end. The inner body extends through the tubular body. The inner body includes a tissue penetrating portion and a tissue cutting portion. The tissue penetrating portion is at a distal end of the inner body. The tissue cutting portion is proximal the distal end of the inner body. The distal end of the tubular body is configured to engage a proximal end of the tissue penetrating portion such that the tubular body can be used to drive the tissue penetration portion distally and yet be withdrawn proximally from about the inner body. 
     Disclosed herein is a method for releasing a ligament. In one embodiment, the method includes: percutaneously penetrating at a first location with an introducer including a distal end and a proximal end; providing a flexible body including a first end, a second end and a length extending between the first end and the second end and including a tissue cutting portion; routing the first end distally through the introducer, around the ligament and proximally back through the introducer such that the length forms a loop around the ligament, the loop distally extending from the distal end of the introducer, the first end and the second end proximally extending from the proximal end of the introducer; and employing the tissue cutting portion to release the ligament. The tissue cutting portion may include a plurality of teeth or an abrasive surface. 
     In one version of the embodiment, the method further includes employing an elongated body configured to be extended through the introducer proximal to distal to engage the first end and pull the first end around the ligament and through the introducer to form the loop. 
     In one version of the embodiment, the method further includes securing a handle to at least one of the first end or second end. In one version of the embodiment, the method further includes employing a nerve sensing system to position the tissue cutting portion away from a nerve. 
     Disclosed herein is a handboard assembly for securing a hand and forearm of a patient undergoing a carpal tunnel surgery. In one embodiment, the assembly includes: a chassis base including a first end and a second end; and a flex board including a third end, a fourth end, a first planar region adjacent the third end, a second planar region adjacent the fourth end and a flex region between the first planar region and the second planar region, the third end operably coupled to the first end and the fourth end operably coupled to the second end, the flex region configured to result in a bend in the flex board when the first planar region and the second planar region are each caused to assume an incline relative to the chassis base. The first planar region may be adapted to receive the hand and the second planar region is adapted to receive the forearm. The first planar region may include a finger receiving portion with a finger securing mechanism and a thumb receiving portion with a thumb securing mechanism, and the second planar region includes a forearm securing mechanism. At least one of the finger securing mechanism, thumb securing mechanism, or the forearm securing mechanism may include a strap arrangement. The strap arrangement may include hook and loop regions. 
     While multiple embodiments are disclosed, still other embodiments of the present invention will become apparent to those skilled in the art from the following detailed description, which shows and describes illustrative embodiments of the invention. As will be realized, the invention is capable of modifications in various aspects, all without departing from the spirit and scope of the present invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not restrictive. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         FIG. 1  illustrates a non-compressed carpal tunnel area of a wrist and palm of a hand. 
         FIG. 2  illustrates a compressed carpal tunnel area of a wrist and palm of a hand. 
         FIG. 3  depicts an open release surgical procedure being performed on the compressed carpal tunnel area of  FIG. 2 . 
         FIG. 4  depicts an endoscopic release surgical procedure being performed on the compressed carpal tunnel area of  FIG. 2 . 
         FIG. 5  illustrates placement of an introducer into the carpal tunnel area of  FIG. 2 . 
         FIG. 6A  depicts one embodiment of a release system showing introduction of an elongated body through the introducer into the carpal tunnel area of  FIG. 2 . 
         FIG. 6A-1  depicts a plurality of embodiments of the elongated bodies of  FIG. 6A . 
         FIG. 6A-2  depicts one embodiment of the elongated body of  FIG. 6A  with an hamate bone indicator notch. 
         FIG. 6A-3  depicts one embodiment of the elongated body of  FIG. 6A  with a Doppler probe to identify structures within the hand. 
         FIG. 6B  illustrates the release system of  FIG. 6A , wherein an internal cutting wire or other cutting member is being introduced through the elongated body. 
         FIG. 6B-1  depicts the release system of  FIG. 6A  with a skin grommet at the introduction point on the skin. 
         FIG. 6C  depicts one embodiment of the elongated body of  FIG. 6A , wherein a cutting member is also shown. 
         FIG. 6D  is an enlarged view of a segment of the elongated body of  FIG. 6C . 
         FIG. 6E  depicts another embodiment of the elongated body of  FIG. 6A , wherein a cutting member is also shown. 
         FIG. 6F  is an enlarged view of a segment of the elongated body of  FIG. 6E . 
         FIG. 6G  depicts still another embodiment of the elongated body of  FIG. 6A  wherein a cutting member is also shown. 
         FIG. 6H  is an enlarged view of a segment of the elongated body of  FIG. 6G . 
         FIG. 7A  depicts another embodiment of the release system, wherein an elongated body is shown connected to one embodiment of a handle member, and the hand and the introducer are not shown for clarity purposes. 
         FIG. 7B  depicts the elongated body of  FIG. 7A , wherein one embodiment of the internal cutting wire of  FIG. 6B  is introduced through the elongated body. 
         FIG. 7C  depicts the elongated body of  FIG. 7A , wherein a cutting member is shown. 
         FIG. 7D  illustrates the elongated body and handle members of  FIG. 7C  wherein the hand is shown. 
         FIG. 8A  depicts another embodiment of the release system, wherein an elongated body is shown connected to one embodiment of a handle member and the hand and the introducer are not shown for clarity purposes. 
         FIG. 8B  depicts the elongated body of  FIG. 8A  wherein one embodiment of the internal cutting wire of  FIG. 6B  is introduced through the elongated body. 
         FIG. 8C  depicts the elongated body of  FIG. 8A , wherein a cutting member is shown. 
         FIG. 8D  illustrates the elongated body and internal cutting wire of  FIG. 8B  wherein the hand is shown. 
         FIG. 9A  depicts another embodiment of the release system of  FIG. 6B  wherein an additional introducer is not shown for clarity purposes. 
         FIG. 9B  illustrates placement of the embodiment of  FIG. 9A  into the carpal tunnel area of  FIG. 2 . 
         FIG. 9C  illustrates the embodiment of  FIG. 9B  wherein a cutting member or internal cutting wire is exposed. 
         FIG. 9D  depicts the embodiment of  FIG. 9B  wherein a securing member is also shown. 
         FIG. 9E  depicts the embodiment of  FIG. 9D  wherein the cutting member is shown releasing a transverse carpal ligament (TCL). 
         FIG. 9E-1  depicts an enlarged view of the cutting member releasing the TCL of  FIG. 9E . 
         FIG. 10A  depicts another embodiment of the release system, wherein a cutting wire is being introduced into the carpal tunnel area of  FIG. 2 , and wherein one embodiment of a sled member is shown but an introducer is not shown for clarity purposes. 
         FIG. 10B  is an enlarged view of the sled member of  FIG. 10A . 
         FIG. 10C  is a cross-section view of the sled member about section line  10 - 10  of  FIG. 10B . 
         FIG. 10D  illustrates placement of the embodiment of  FIG. 10A  under the TCL. 
         FIG. 10E  depicts the embodiment of  FIG. 10A  wherein the cutting wire is shown exiting the palm of the hand. 
         FIG. 10F  depicts the system of  FIG. 10A  wherein a cutting member (not shown) is used to release the TCL. 
         FIG. 11A  depicts another embodiment of the release system, wherein a cutting wire is being introduced into the carpal tunnel area of  FIG. 2 , and wherein another embodiment of a sled member is shown. 
         FIG. 11B  is an enlarged view of the sled member of  FIG. 11A . 
         FIG. 11C  is a cross-section view of the sled member about section line  11 - 11  of  FIG. 11B . 
         FIG. 12A  illustrates still another embodiment of the system, wherein a first elongated body is being introduced under the TCL. 
         FIG. 12B  depicts the system of  FIG. 12A  wherein a second elongated body with a hook member is introduced to the subcutaneous tissue above the TCL. 
         FIG. 12C  illustrates the system of  FIG. 12B  wherein the first elongated body has formed a loop structure about the TCL. 
         FIG. 12D  illustrates the system of  FIG. 12C  wherein a proximal end and a distal end of the first elongated body is operably connected to a handle member and the TCL is being released. 
         FIG. 13A  illustrates still another embodiment of the system, wherein both an elongated body and a forceps device have been introduced into the carpal tunnel area/subcutaneous tissue of  FIG. 2 . 
         FIG. 13B  is the same view as  FIG. 13A  except the forceps device has fully engaged the elongated body. 
         FIG. 14A  illustrates an embodiment of the release system for treatment of plantar fasciitis, showing placement of an introducer into a foot. 
         FIG. 14B  depicts introduction of an elongated body through the introducer under a plantar fascia of the foot. 
         FIG. 14C  depicts the elongated body releasing the plantar fascia. 
         FIG. 15A  depicts still another embodiment of a release system having a delivery or deployment instrument, a handle member and a return shaft member. 
         FIG. 15B  depicts the delivery or deployment instrument of  FIG. 15A . 
         FIG. 15C  is the same view as  FIG. 15B  except a cutting member delivery device is also shown. 
         FIG. 15D  is the same view as  FIG. 15C  except the cutting member delivery device is being deployed. 
         FIG. 15E  is an enlarged view of a distal end of the delivery or deployment instrument of  FIG. 15D . 
         FIG. 15F  is still another enlarged view of the distal end of the delivery or deployment instrument of  FIG. 15D . 
         FIG. 15G  depicts the return shaft member of  FIG. 15A . 
         FIG. 15H  depicts an enlarged view of a distal end of the return shaft member of  FIG. 15G . 
         FIG. 15I  is a transparent view of the return shaft member of  FIG. 15H . 
         FIG. 15J  is a top side view of the return shaft member of  FIG. 15H . 
         FIG. 15K  depicts the handle member of  FIG. 15A . 
         FIG. 15L  is the same view as  FIG. 15K  except an abrasive suture material is also shown positioned on the handle member. 
         FIG. 16A  depicts still another embodiment of a release system including an introducer and an elongated body. 
         FIG. 16B  depicts the release system of  FIG. 16A , wherein handle members are shown operably connected to the elongated body and the elongated body is introduced into the carpal tunnel region of  FIG. 2 . 
         FIG. 16C  is the same view as  FIG. 16B , except a cutting member is shown exiting the palm of the hand. 
         FIG. 16D  is the same view as  FIG. 160 , except the cutting member is shown operably connected to a handle member. 
         FIG. 16E  is the same view as  FIG. 160 , except the introducer is being withdrawn from an entry site in the palm of the hand. 
         FIG. 16F  is the same view as  FIG. 16E , except the withdrawn introducer is being held in place by a motion limiting feature. 
         FIGS. 16G and 16H  are the same view as  FIG. 16F  wherein the cutting member is positioned in the carpal tunnel region to release the TCL. 
         FIG. 17A  depicts another embodiment of a release system including a handboard assembly and handle members. 
         FIG. 17B-1  depicts an exploded view of the handboard assembly of  FIG. 17A . 
         FIG. 17B-2  is a top isometric view of a baseplate chassis of the handboard assembly of  FIG. 17A . 
         FIG. 17B-3  is a bottom elevation view of the baseplate chassis of  FIG. 17B-2 . 
         FIG. 17B-4  is a top elevation view of a flexboard of the handboard assembly of  FIG. 17A . 
         FIG. 17B-5  is an isometric view looking from the bottom and side of a drape assembly of the handboard assembly of  FIG. 17A . 
         FIG. 17B-6  is an exploded top elevation view of the drape assembly of  FIG. 17B-5 . 
         FIG. 17B-7A  is a side isometric view of a handboard assembly with a balloon adjustment mechanism. 
         FIG. 17B-7B  is a top isometric view of the handboard assembly of  FIG. 17B-7A  with the balloon adjustment mechanism. 
         FIG. 17B-8A  is a side isometric view of a handboard assembly with a ratchet adjustment mechanism. 
         FIG. 17B-8B  is a top isometric view of the handboard assembly of  FIG. 17B-8A  with the ratchet adjustment mechanism. 
         FIG. 17B-8C  is a side view of the ratchet adjustment mechanism of the handboard assembly of  FIG. 17B-8A . 
         FIG. 17B-9A  is a side isometric view of a handboard assembly with a rack and pinion adjustment mechanism. 
         FIG. 17B-9B  is a top isometric view of the handboard assembly of  FIG. 17B-9A  with the rack and pinion adjustment mechanism. 
         FIG. 17B-10A  is a side isometric view of a handboard assembly with a scissor adjustment mechanism. 
         FIG. 17B-10B  is a top isometric view of the handboard assembly of  FIG. 17B-10A  with the scissor adjustment mechanism. 
         FIG. 17B-11A  is a side isometric view of a handboard assembly with a screw adjustment mechanism. 
         FIG. 17B-11B  is a top isometric view of the handboard assembly of  FIG. 17B-11A  with the screw adjustment mechanism. 
         FIG. 17B-12A  is a side isometric view of a handboard assembly with a drape glove over the assembly. 
         FIG. 17B-12B  is a top isometric view of the handboard assembly of  FIG. 17B-12A  with the drape glove over the assembly. 
         FIG. 17B-13  is a top isometric view of a handboard assembly including a thumb girdle. 
         FIG. 17C-1  is an isometric view of a proximal handle assembly of the system of  FIG. 17A . 
         FIG. 17C-2  is an exploded view of a first side of the proximal handle assembly of  FIG. 17C-1 . 
         FIG. 17C-3  is an exploded view of a second side of the proximal handle assembly of  FIG. 17C-1 . 
         FIG. 17C-4  is an isometric view of a distal end of a cutting wire assembly of the proximal handle assembly of  FIG. 17C-1 . 
         FIG. 17C-5  is an isometric view of a probe wire assembly of the proximal handle assembly of  FIG. 17C-1 . 
         FIG. 17D-1  is an isometric view of a first embodiment of an introducer assembly of the system of  FIG. 17A . 
         FIG. 17D-2  is an isometric view of a second embodiment of an introducer assembly of the system of  FIG. 17A . 
         FIG. 17E-1  is an isometric view of a shaft lock assembly of the system of  FIG. 17A . 
         FIG. 17E-2  is a side view of the shaft lock assembly of  FIG. 17E-2 . 
         FIG. 17E-3  is a cross-sectional elevation of the shaft lock assembly taken about section line A-A of  FIG. 17E-2 . 
         FIG. 17F-1  is an isometric view from the front of a distal handle assembly of the system of  FIG. 17A . 
         FIG. 17F-2  is an isometric view from the back of a distal handle assembly of the system of  FIG. 17A . 
         FIG. 17F-3  is an exploded view of the distal handle assembly of  FIG. 17F-1 . 
         FIG. 17F-4  is an exploded view of the distal handle assembly of  FIG. 17F-2 . 
         FIG. 17G-1  is a side view of a distal end of a nerve wire assembly of the system of  FIG. 17A . 
         FIG. 17G-2  is an exploded view of the distal end of the nerve wire assembly of  FIG. 17G-1 . 
         FIG. 17H  illustrates the proximal handle assembly and the distal handle assembly of  FIG. 17A  operably connected for a release procedure, wherein the hand is not shown for clarity. 
         FIG. 18  depicts still another embodiment of a release system including a hardboard assembly and handle members, wherein a nerve detection system and a different embodiment of a distal handle are also shown. 
       FIGS.  19 A- 19 E- 2  illustrate various additional embodiments of a cutting member which may be used with a release system according to the present disclosure. 
         FIGS. 20A-20F  illustrate various embodiments of a nerve detection system which may be used with a release system according to the present disclosure. 
         FIGS. 21A-21G  illustrate various additional embodiments of a handle member which may be used with a release system according to the present disclosure. 
         FIGS. 22A-1  &amp;  22 A- 2  depict another embodiment of the release system, wherein a tubular body is shown connected to one embodiment of a handle member and the tubular body including a nerve detector. 
         FIGS. 22B-1  &amp;  22 B- 2  depict another embodiment of the release system, wherein a tubular body is longitudinally displaced to expose a cutting member within the tubular body. 
         FIGS. 22C-1  &amp;  22 C- 2  depict an embodiment of the release system with a handle member wherein a tubular body and cutting member are longitudinally displaced to expose the cutting member within the tubular body. 
         FIGS. 22D-1  &amp;  22 D- 2  depict a first embodiment of the release system wherein the tubular body is rotatably and/or longitudinally displaced. 
         FIGS. 22E-1  &amp;  22 E- 2  depict a second embodiment of the release system wherein the tubular body is rotatably and/or longitudinally displaced. 
         FIGS. 22F-1  &amp;  22 F- 2  depict an embodiment of the release system wherein the tubular body is longitudinally displaced to expose a tissue cutting surface of the cutting member within a window in the tubular body. 
         FIGS. 22G-1  &amp;  22 G- 2  depict an embodiment of the release system wherein the tubular body is longitudinally displaced to expose a tissue cutting tooth of the cutting member within a window in the tubular body. 
         FIGS. 22H-1  &amp;  22 H- 2  depict an embodiment of the release system wherein the tubular body includes a hinged flap. 
         FIG. 22I-1  is an isometric view of an embodiment of the release system wherein the tubular body may be rotatable about its longitudinal axis relative to the cutting member and/or the cutting member may be rotatable about its longitudinal axis relative to the tubular body so as to expose the cutting features of the cutting member within a window of the tubular body. 
         FIG. 22I-2  is an enlarged isometric view of the tubular body of  FIG. 22I-1  wherein the tubular body and cutting member are rotated relative to each other such that the cutting features are not exposed in the window of the tubular body. 
         FIG. 22I-3  is a longitudinal cross secton of the tubular body in the condition depicted in  FIG. 22I-2 . 
         FIG. 22I-4  is the same view as  FIG. 22I-2  except the tubular body and cutting member are rotated relative to each other such that the cutting features are exposed in the window of the tubular body. 
         FIG. 22I-5  is a longitudinal cross secton of the tubular body in the condition depicted in  FIG. 22I-4 . 
         FIGS. 22J-1  &amp;  22 J- 2  depict an embodiment of the release system wherein the flexible body is longitudinally displaced to create a bowstring effect. 
         FIGS. 22K-1  &amp;  22 K- 2  depict an embodiment of the release system with a handle member wherein a tubular body and/or a cutting member are longitudinally displaced to expose a cutting surface of the cutting member and the tubular body and cutting member have a curved opposing shape. 
         FIG. 23  depicts an embodiment of the release system conducted with a single puncture. 
         FIG. 24A  is a distal-proximal cross section of a patient&#39;s wrist wherein another embodiment of the release system is being employed, the release system having a cutting member distally terminating in a penetrating element, the penetrating element being pushed through the wrist tissue via a tubular body. 
         FIGS. 24B and 24C  are longitudinal cross sections of the penetrating member and tubular body and illustrating two embodiments of a coupling arrangement between the penetrating member and the tubular body. 
         FIG. 24D  is the same view as  FIG. 24A , except the tubular body is being withdrawn from about the cutting member, which has been properly located for severing the TCL. 
         FIG. 24E  is the same view as  FIG. 24D , except the cutting member is being displaced to sever the TCL. 
     
    
    
     DETAILED DESCRIPTION 
     Disclosed herein is an incisionless method and system for releasing the transverse carpal ligament (TCL) to decompress the median nerve. In some embodiments, the method (technique) or system includes needle stick introducer access into the general carpal tunnel area. An elongated or tubular body, such as a hollow wire or cannula, may be introduced into the carpal tunnel area through the introducer and a surgeon may safely guide the elongated body through the compressed carpal tunnel area to an exit point at, near or in the palm of the hand. The elongated body may include cutting members and may include a probe member or the probe member may be a separate instrument. The elongated body may be operably connected to a neuro-monitoring device to help the surgeon guide the elongated body into proper placement under the TCL without injuring the median nerve. An internal cutting wire may be introduced into the elongated body and extended to the exit point where it will exit the palm such that the distal end of the elongated body can be retrieved and be operably connected to a handle member. The cutting member(s) or internal cutting wire may be a flexible body and may include tissue cutting portions. In some embodiments, the cutting members may also be the tissue cutting portions. In other embodiments, the internal cutting wire may exit the palm such that the distal end of the wire can be retrieved and be operably connected to a handle member. In some embodiments, the internal cutting wire may include cutting members or tissue cutting portions and a penetration tip. In still other embodiments, the internal cutting wire may not exit the palm and may be operably coupled to a second elongated body introduced into the carpal tunnel area. In still other embodiments, an abrasive suture material may be introduced into the elongated body via a cutting member delivery device, such as a needle. The abrasive suture material and the cutting member delivery device may be extended to an exit point or opening in the palm where both will exit the palm. The abrasive suture material may be operably connected to a handle member. 
     The hand may be immobilized. In some embodiments, a distal end of an abrasive suture or other cutting member or flexible body may be stabilized or immobilized at the palm of the hand or may be coupled to a handle member. A proximal end of the abrasive suture or other cutting member may also be operably connected to a handle member. The surgeon may then use the handle member(s) to displace the cutting member (e.g. abrasive suture, internal cutting wire with cutting member or cutting member of the elongated body) along the TCL, such that the cutting member can release the TCL, such as by cutting, flossing, or sawing through the TCL, thereby decompressing the median nerve. Thus, the presently disclosed system and method do not require a large incision, as required for the open surgery technique, and the specialized equipment and knowledge required for the endoscopic release surgery are also unnecessary. This may increase the efficiency of the surgery and reduce surgical complications that may result from, for example, a large open incision. As explained below in more detail with respect to  FIGS. 14A-14C , the systems and methods disclosed herein may also be used to release the plantar fascia in the foot. The systems and methods disclosed herein may also be used to decompress the ulnar nerve to treat cubital tunnel syndrome or Guyon&#39;s canal syndrome. With cubital tunnel syndrome, the ulnar nerve is compressed by the humerus bone. The system as disclosed herein may shave down this bone to relieve compression on the nerve. Guyon&#39;s canal syndrome is compression of the ulnar nerve, by, for example, a cyst or a ligament, e.g. the volnar radio-ulnar ligament. The systems and methods disclosed herein may be used to release that ligament which is compressing the ulnar nerve. 
     For a detailed description of a system and method for releasing the TCL to decompress the median nerve, reference is first made to  FIGS. 5-8D .  FIG. 5  illustrates placement of an introducer  35  into the carpal tunnel area  5  of  FIG. 2 .  FIG. 6A  depicts introduction of an elongated body  40  through the introducer  35  into the carpal tunnel area  5  of  FIG. 2 .  FIG. 6B  illustrates an internal cutting wire  47  or other cutting member  45  being introduced through the elongated body  40 . 
     As can be understood from  FIGS. 5-68 , the system  100  may include an introducer  35  and an elongated body  40  including a blunt tip  42  and a cutting member  45 . In some embodiments, the introducer  35  may be a 2 cm introducer needle (16-18 gauge) that may be inserted through a needle stick access. In some embodiments, the introducer  35  may be a 14 gauge introducer needle. It can be appreciated that the introducer  35  may be used in various embodiments described herein but is not required to be present throughout the procedure. 
     The elongated body  40  may be a supple metal wire or a similar sized cannula or other hollow-type body. In some embodiments, the elongated body may be an abrasive material, such as an abrasive suture. The elongated body  40  may also include cutting member  45 . The elongated body  40  may have a blunt ball point tip or blunt probe  42  to prevent nerve irritation or nerve or tendon damage as it is passed through the carpal tunnel parallel to the nerve and flexor tendons from proximal to distal. The distal end  43  of the elongated body  40  may naturally assume a curled shape such that when it is passed through the tunnel into the palm, the tip  42  trajectory is upwards towards the palm skin. 
     In one embodiment,  FIG. 6A-1  depicts three differently-sized examples of the elongated body  40  and the blunt ball point tip  42 . In one particular embodiment, the elongated body  40  may have a contoured portion  900  that extends proximally from the blunt ball point tipe  42  until transitioning into a generally straight portion  905  that continues proximally to generally form the rest of the elongated body  40 . The contoured portion may be generally curved so as to be contoured to the 3.5 centimeter proximal-distal length of the average carpal tunnel. 
     In addition as indicated by arrow A in  FIG. 6A-1 , some embodiments of the blunt ball point tip  42  may include serrated edges, ribs, ridges  910  or other tactile features along the dorsal surface of the blunt ball  42  that, when displaced against certain tissue within the wrist, the tactile features  910  provide a vibration or other tactile sensation through the elongated body  40  to the hand of an operator to indicate to the operator of the proper placement of the elongate body  40  within the carpal tunnel. For example, the transverse ribs  910  on the dorsal surface of the blunt ball  42  may provide tactile indications to the user when the transverse ribs  910  rub along the texture of the ligament  20  when the elongated body  40  is moved distally within the wrist. Thus, such a rib-equipped ball end elongated body  40  can be used to identify the location of the target ligament  20 . 
     In one embodiment, the elongate bodies  40  depicted in  FIG. 6A-1  are probes with ball-ends  42 , wherein the probe is inserted into the wrist to clear the way through the wrist before the elongate body  40  or cutting device  47  of  FIG. 6B  are inserted into the wrist to make possible severing the ligament  20 . The ball-end probes depicted in  FIG. 6A-1  may have an electrode capability such that it can be used to identify the location of nerves. Such ball-end probes  42  may be provided as part of a surgical kit including the introducer  35 , elongate body  42  and cutting device  47  illustrated in  FIG. 6B . Such a surgical kit may be sterile packaged and include instructions for using the kit in the context of a surgery, such as, for example, a carpel tunnel surgical procedure. 
       FIG. 6A-2  depicts another embodiment of the elongated body  40  of  FIG. 6A , wherein the elongate body includes a hamate bone landmark indicator  41  along the surface of the elongated body. The hamate bone  41 - 1  is a landmark within the carpal tunnel that includes a ledge that may be detected by the interaction between the hamate bone ledge and the indicator  41 , which may be in the form of a circumferentially extending ring or ridge  41  on the circumferential surface of the elongated body  40 . Thus, the indicator  41  on the elongated body  40  may be used to indicate to a physician that the elongated body is properly located within the carpal tunnel. To aid in locating the hamate bone  41 - 1 , the elongated body  40  may include a small transverse circumferential ridge  41  on the outer circumferential surface of the elongated body that approximates anatomically the arch of the ledge of the hamate bone  41 - 1  in height, size, shape, etc. When the ridge  41  comes into contact with the hamate bone  41 - 1 , a tactical feedback is provided along the elongated body  40  to the user of the body to indicate that the hamate bone has been reached by the elongate body  40 . 
     In one embodiment, the elongate body  40  depicted in  FIG. 6A-2  is a probe with the hamate bone indicator  41 , wherein the probe is inserted into the wrist to clear the way through the wrist before the elongate body  40  or cutting device  47  of  FIG. 6B  are inserted into the wrist to make possible severing the ligament  20 . The indicator ridge equipped probe depicted in  FIG. 6A-2  may have an electrode capability such that it can be used to identify the location of nerves. Such indicator ridge equipped probes may be provided as part of a surgical kit including the introducer  35 , elongate body  42  and cutting device  47  illustrated in  FIG. 6B . Such a surgical kit may be sterile packaged and include instructions for using the kit in the context of a surgery, such as, for example, a carpel tunnel surgical procedure. 
     The elongated body  40  may have neuro monitoring features, such as a supple metal probe, that may be used in conjunction with neuro monitoring systems or nerve detection systems (see, for example,  FIG. 18  or  FIGS. 20A-20F ) to help guide the elongated body  40  through the carpal tunnel area without harming nearby nerves and such that the body  40  is properly positioned under the TCL. In some embodiments, the neuro monitoring system may be the system offered by Cadwell Laboratories, Inc., Kennewick, Wash., Biotronic, Ann Arbor, Mich. or Medtronic, Minneapolis, Minn. The supple metal probe, such as the blunt probe tip  42 , is also attached to a nerve monitor to assist the surgeon in navigation under the TCL. It can be appreciated that the probe may also be a separate instrument from the elongated body. The surgeon can identify median nerve irritation and accordingly alter the course of the body  40  with hand movements or remove the body  40  and start over again. 
     In various embodiments the body  40  may be partially coated with a non-conductive material such that only a portion of the diameter of the body  40  is exposed for nerve stimulation. 
     As indicated in  FIG. 6A-3 , the elongated body  40  may also have a Doppler probe  42 - 1  located at the distal tip  42  of the elongated body. The Doppler probe  42 - 1  may be integrated with or into other features of the elongated body  40 , such as the blunt ball point tip  42  described above. In general, the Doppler probe  42 - 1  may aid in identifying structures within the hand  10  during the compressed nerves release treatment. For example, the Doppler probe  42 - 1  may identify the palmer arch artery  42 - 2  within the palm of the hand  10  to warn the user that the elongated body  40  is approaching the artery. The Doppler probe  42 - 1  may provide one or more electrical signals through the elongated body  40  to a Doppler monitoring system that provides the feedback to the user of the probe. Use of the Doppler probe  42 - 1  may aid in prevention of injury to the hand  10  during the release procedure. 
     In one embodiment, the elongate body  40  depicted in  FIG. 6A-3  is a probe with the Doppler probe  42 - 1 , wherein the probe is inserted into the wrist to clear the way through the wrist before the elongate body  40  or cutting device  47  of  FIG. 6B  are inserted into the wrist to make possible severing the ligament  20 . The Doppler probe equipped probe depicted in  FIG. 6A-2  may have an electrode capability such that it can be used to identify the location of nerves. Such Doppler probe equipped probes may be provided as part of a surgical kit including the introducer  35 , elongate body  42  and cutting device  47  illustrated in  FIG. 6B . Such a surgical kit may be sterile packaged and include instructions for using the kit in the context of a surgery, such as, for example, a carpel tunnel surgical procedure. Such a surgical kit may also include any or all of the other probes discussed above with respect to  FIGS. 6A-1  and  6 A- 2 . 
     For a more detailed discussion of the cutting member  45  of the elongated body, reference is now made to  FIGS. 6C-6H , which illustrate various embodiments of the cutting member  45 . In some embodiments, the cutting member may be an abrasive suture material  255 , such as discussed below with respect to  FIG. 15L , or an internal cutting wire  47 , such as discussed below with respect to  FIGS. 6C-6H . It can be appreciated that the elongated body  40  may include the cutting member  45  or the cutting member  45  may be a separate cutting instrument that is passed or inserted over or through the elongated body to a site below the TCL. That is, and as discussed in more detail below, in some embodiments, the cutting member  45  may be integral with the elongated body  40  and the elongated body is operably attached to at least one handle member, while in some embodiments, the cutting member  45  may be displaceable with respect to the body while the body remains in a fixed location or is in a stationary position, and in still other embodiments, the cutting member  45  may be separate from and displaceable with respect to the body such that the cutting member  45  is operably attached to the handle members. 
     As can be understood from  FIGS. 6C and 6D , the cutting member  45  may be coated with non-conductive smooth material on three sides with the exposed metal surface having multiple shark teeth, single tooth, abrasive surface, or long sharp surface that is electrified. If the cutting member comes in contact with the nerve, it will be detected by the nerve monitor. If there is nerve stimulation, the surgeon can adjust or alternatively re-pass the elongated body  40 . The cutting member may then be used to saw or cut through the ligament. 
     In some embodiments, the cutting member  45  may be a round, triangular shaped or other configuration such that surgeon can recognize the directional surface that cuts and accordingly hold the elongated body such that the surface of the cutting member is in contact with the TCL. 
     As shown in  FIGS. 6E and 6F , in one embodiment, there is no coating on the elongated body and the cutting member has exposed teeth placed along a substantial length of the elongated body such that the entire TCL could be released through a single unidirectional pull of the elongated body. 
     As can be understood from  FIGS. 6G and 6H , the cutting member  45  may be exposed through the body  40  via only a small window  46  where the body  40  is not coated with a non conductive material. The size of this small window  46  corresponds with the proximal/distal length of the TCL being cut/released. By exposing a smaller cutting surface, the risk of nerve irritation or damage is reduced. 
     As can be understood from  FIGS. 6C-6H  and  16 A-H (and others), in some embodiments where the cutting member is not a part of the body  40 , the body may have a window cut out on one dorsal surface. The window is the same length or smaller then the proximal to distal length of the TCL. The window is positioned under the TCL. A cutting member with a single tooth, multiple teeth, sharp or abraded surface or other element for cutting is passed through the body that cuts only at or near the site of the window. 
     As discussed in more detail below and with reference to, for example,  FIGS. 15A-15L  and FIGS.  19 A- 19 E- 2  (and others), in some embodiments, the cutting member  45  (which may be an abrasive suture or other abrasive material  255 ) may be separate from and displaceable with respect to the body such that the cutting member  45  is operably attached to a handle member while the body  40  is at or below, but does not exit, the exit point of the hand  10 . In some embodiments, the elongated body may be an abrasive material and may be operably connected to handle members (see  FIGS. 12A-12D ). 
     As can be understood from  FIG. 6B , once the elongated body  40  has been introduced under the TCL and extended to an appropriate exit point  51  in the palm, a stylet or internal cutting or piercing wire  47  may be advanced to the distal end  43  of the elongated body  40 . This cutting wire  47  may exit a port  44  in the ball point tip  42  and pierce the skin on the palm for access to the distal end  43  of the elongated body  40 . In addition, as shown in  FIG. 6B-1 , a plastic grommet  44 - 1  or covering may be adhered to via an adhesive, sutured to, or press fit into the skin of the palm  10  at the location of the pierce. The grommet  44 - 1  may prevent inadvertent cutting or tearing of the skin during the procedure. A similar grommet  44 - 1  may also be similarly located on the skin at the insertion site. The surgical kit may include two or more such grommets  44 . 
     In other embodiments, the ball tip  42  can emit a light that can be identified in the subcutaneous tissues and a small stab wound made to retrieve the probe  42  and deliver the cutting wire  47  or cutting member  45  to the surface. 
     The surgeon may grasp the distal end  43  of the elongated body  40  and, together with the proximal end of the elongated body, both ends of the elongated body may be operably connected to handle members. In some embodiments, the surgeon may instead grasp the distal end of the cutting member  45  or cutting wire  47  that has extended through the exit point of the hand and both the distal end of the cutting member  45  or wire  47  and the proximal end of the elongated body may be operably connected to handle members. In still other embodiments, the distal end of the cutting member  45  or the elongated body  40  may not exit the palm at the exit point but may be operably attached to a second elongated body introduced into the carpal tunnel region. The second elongated body may be used to withdraw the distal end of the first elongated body through the wrist entry point such that both the proximal and distal ends of the first elongated body may be operably connected to a handle member(s). In some embodiments, both the distal and proximal ends of the cutting member  45  or wire  47  may be operably connected to handle members  50 . 
     For a more detailed discussion of the handle members, reference is now made to  FIGS. 7A-8D  and  21 A- 21 G, which depict various embodiments of the handle members  50  of the system  100 . As can be understood from  FIGS. 7A-8D , the elongated body  40  may be exposed at both its proximal and distal ends. The elongated body  40  is placed underneath the TCL such that the ligament can be cut through a back and forth sawing action by the cutting member  45 . In embodiments where the cutting member is a separate instrument, the distal and proximal ends of the separate cutting instrument may be operably connected to the handle members and the sawing or cutting motion happens as described below. That is, although  FIGS. 7A-8D  show handle members attached to the body  40 , in other embodiments, the handle members  50  may be operably attached to the cutting member  45  or internal cutting wire  47 . This sawing/cutting action is achieved by pulling the elongated body or the cutting member back and forth. 
     As shown in  FIGS. 7A-7D , in one embodiment, the handle members  50  may be grip handles with an actuator  55 . As can be understood from  FIGS. 7A-7C  (the hand is not shown for clarity), a first grip handle member  50  includes the actuator  55  in a channel  56 , and the actuator  55  may be displaced relative to the grip handle  50 , thereby extending the internal cutting wire  47  and exposing the cutting member  45  in the window  46 . As shown in  FIGS. 7C and 7D , the elongated body  40  and internal cutting wire  47  are operably connected to a second handle member  50 . As indicated in  FIG. 7D  (which shows the system in the hand), the actuator  55  is displaced relative to the first handle member within the channel  56 , thereby inducing a cutting, sawing or other motion to release the TCL to decompress the median nerve. 
     As illustrated in  FIGS. 8A-8D , in one embodiment, the handle member  50  may be a trigger grip handle that first extends the external cutting wire  47  such that the cutting member  45  is exposed within the window  46  and then the internal cutting wire  47  is pulled back and forth through finger/hand actuated trigger grips while the body remains in location. Because the cutting member  45  is properly placed under the TCL, the back and forth movement of the cutting member will release the TCL thereby decompressing the median nerve. 
     As can be understood from FIGS.  21 A and  21 C-G, the elongated body  40  may be exposed at both its proximal and distal ends. The elongated body  40  is placed underneath the TCL such that the ligament can be cut through a back and forth sawing action by the cutting member  45 . As can be understood from  FIG. 21B , in embodiments where the cutting member  45  is a separate instrument, the distal and proximal ends of the separate cutting instrument may be operably connected to the handle members  50  and the sawing or cutting motion happens as described herein. That is, although FIGS.  21 A and  21 C-G show handle members attached to the body  40 , in other embodiments, as shown in  FIG. 21B  (and others), the handle members  50  may be operably attached to the cutting member  45 . This sawing/cutting action is achieved by displacing the cutting member. In still other embodiments where the cutting member  45  is a separate instrument, for example  FIGS. 17A-17H , a proximal end of the elongated body  40  may be operably attached to a handle member  50  and a distal end of the cutting member  45  may be operably attached to a second handle member  50 . 
       FIGS. 21A and 21B  illustrate embodiments of the system including handle members  50  and a neuro-monitoring or nerve detection system  500 . As can be understood from  FIG. 21A , the system  100  may also include short hollow metal tubes  60  that can be placed onto the proximal and distal portions of the hand and positioned through the skin surface to prevent skin laceration from the elongated body  40  as the cutting member is displaced to saw or cut through the TCL. As can be understood from  FIG. 21B , in some embodiments, the cutting member  45  may be separate from and displaceable with respect to the body  40  such that the cutting member  45  is operably attached to the handle members while the body  40  is affixed, for example by an adhesive attachment  61 ,  62  of the distal and proximal ends of the body  40  to the entry and exit points of the hand  10 . 
     As shown in  FIGS. 21A and 21B , the handle members  50  may be elongated oval shaped handles which may provide feedback to the surgeon&#39;s fingers or fine motor skills during the sawing or cutting motion as described herein. 
     As indicated in  FIG. 21C , in one embodiment, the handle members  50  may be D shaped handles which may also provide feedback to the surgeon&#39;s fingers/fine motor skills during the sawing/cutting motion. 
     As illustrated in  FIG. 21D , in one embodiment, the handle members  50  may be trigger grip handles that pull the elongated body  40  back and forth through finger/hand actuated trigger grips. In another embodiment, the trigger grip handles may pull the cutting member  45  back and forth through finger/hand actuated trigger grips while the body  40  remains in location. 
     As indicated in  FIG. 21E , in one embodiment, the handle members  50  may be rotating knobs that are anchored on a hand stabilization system  2100 . The knobs facilitate a controlled back and forth movement of the elongated body. The hand stabilization system  2100  may be a sterile hand immobilizer that rigidly fixates the hand such that sawing, flossing or single pull through maneuvers by the surgeon do not move the wrist and inadvertently reposition the wire or cutting member under the TCL, once it has been safely positioned. See  FIGS. 17A-18  for additional embodiments and discussion related to hand immobilization or stabilization systems. 
     As can be understood from  FIG. 21F , in one embodiment, the handle members  50  may be a rotating wire belt for the elongated body  40  and further utilizing a hand stabilization system  2100 . 
     As shown in  FIG. 21G , in one embodiment, the handle members  50  may be hand levers that utilize a hand stabilization system  300  and facilitate back and forth movement of the elongated body  40 . 
     For a more detailed discussion of the embodiments where the elongated body  40  may not exit at the exit point of the hand, reference is now made to  FIGS. 9A-13B , which depict various embodiments of the system in which the distal end of the elongated body does not exit the palm of the hand. 
     As can be understood from  FIGS. 9A-9E , the handle member  50  may be a flat introducer with an actuator  55 . As indicated in  FIGS. 9A-9B , the elongated body  40  is inserted via an introducer (see, for example,  FIG. 5 ) and the actuator  55  is in a first position. As shown in FIGS.  9 C- 9 E- 1 , the elongated body  40  may be flexible such that after insertion under the TCL, it may curl at least slightly at its most distal tip  60 . The actuator  55  is displaced relative to the handle member and the internal cutting wire  47  or cutting member  45  extends from the window  46 , thereby forming a “bow” shape, as can be understood from  FIG. 9E-1 . A distal end of the external cutting wire  47  or cutting member  45  may extend through the exit point of the hand and may be held in place by a securing member  65 , as illustrated in  FIG. 9D . The securing member  65  may be a pin, a needle, a wire, an adhesive or other appropriate securing member, or a combination thereof. In one embodiment, the securing member  65  may be coupled to the cutting wire  47  or cutting member  45  after the cutting wire  47  or cutting member  45  has exited the exit point in the hand  10 . In some embodiments, the securing member  65  may be coupled to the internal cutting wire  47  or cutting member  45  within the elongated body  40  (see e.g.  FIGS. 15C-15F ). Once the distal end of the cutting wire or cutting member is secured at the palm of the hand by the securing member  65  (or a combination of securing members), the actuator  55  is moved between the first and second positions thereby raising and lowering the “bow” (see  FIG. 9E-1 ) created by the internal cutting wire  47  or cutting member  45  and the elongated body  40  is moved in a sawing, cutting or other motion, thereby releasing the TCL and decompressing the median nerve. 
     As can be understood from  FIGS. 10A-10F  and  11 A- 11 C, the internal cutting wire  47  may be received by a sled member  70 . As shown in  FIGS. 10A-10C  and  11 A- 11 C, the sled member  70  may have a variable length and includes a channel  77  that is configured to receive the internal cutting wire  47 . In some embodiments, the sled member may be configured to receive the elongated body  40  which may be an abrasive material or abrasive suture as described in other embodiments. In some embodiments, the sled member may be configured to receive a cutting member  45  as described herein. The distal end  75  of the sled member  70 , which may be rounded ( FIG. 11A-11C ) or slightly pointed ( FIGS. 10A-10C ), is at a slight slope or incline relative to the proximal end  80  of the sled member  70  thereby creating an upslope trajectory to facilitate exit of the cutting wire  47  from the palm of the hand once the sled member is properly positioned under the TCL (see  FIG. 10D ). As shown in  FIG. 10B , the sled member  70  may also include a retaining member  75 , such as a groove snap, to retain the cutting wire  47  in the channel  77  of the sled member  70 . As indicated in  FIGS. 10E and 10F , the internal cutting wire  47  may then be extended from the distal end of the sled member and exit the palm of the hand at the exit point, and secured by a securing member  65  or other appropriate device (e.g. a handle member). The cutting wire  47  is now properly positioned beneath the TCL and is moved in a sawing, cutting or other motion, thereby releasing the TCL and decompressing the median nerve. 
     As can be understood from  FIGS. 12A-12D , the elongated body  40  may be introduced through an introducer  35  into the carpal tunnel region and into its proper position beneath the TCL but without exiting the hand  10  ( FIG. 12A ). As indicated in  FIG. 12B , a second elongated body  85  having a hook end  90  is introduced through the introducer  35  into the subcutaneous tissue above the TCL. The hook end  90  of the second elongated body  85  is advanced towards the distal end  43  of the elongated body  40 , such as the ball point tip  42  of the elongated body  40 , and coupled to the distal end  43  of the elongated body  40 . In some embodiments, the first elongated body  40  and/or the second elongated body  85  may be formed of an abrasive material such as abrasive sutures and introduced to the carpal tunnel region via a sled member  70  as discussed above with reference to  FIGS. 10A-11C . 
     As can be understood from  FIG. 12C , the second elongated body  85  is withdrawn through the introducer, thereby pulling the first elongated body  40  through the subcutaneous space above the TCL and creating a loop structure  95 . A cutting member may be exposed within the loop structure to facilitate release of the TCL. As shown in  FIG. 12D , a proximal end  92 , and a distal end  43  of the elongated body  40  is coupled to a handle member  50  and each handle member  50  is displaced in the opposite direction relative to the other to create a sawing or cutting motion as the loop structure  95  releases the TCL thereby decompressing the median nerve. 
     As can be understood from  FIGS. 13A-138 , the elongated body  40  may be introduced through an introducer  35  into the carpal tunnel region and into its proper position beneath the TCL but without exiting the hand  10 . In some embodiments, the elongated body may be an abrasive material, such as an abrasive suture. As shown in  FIG. 13A , a forceps device  105  may also be introduced through the introducer  35  into the subcutaneous tissue above the TCL. As indicated in  FIG. 13B , the distal end  110  of the forceps  105  is coupled to the ball point tip  42  of the elongated body  40  to securely hold the elongated body  40  about the TCL. The forceps device  105  may be withdrawn subcutaneously, thereby pulling the elongated body  40  into the subcutaneous space above the TCL and creating a loop structure, as described above with reference to  FIGS. 12C and 12D . A cutting member  45  may be exposed at the loop of the loop structure. The proximal and distal ends of the elongated body  40  may be attached to a handle member (such as those depicted in  FIG. 7A-8D  or  21 A- 21 G) and the elongated body may be displaced in a sawing or cutting motion. The sawing or cutting motion releases the TCL thereby decompressing the median nerve. 
     For a discussion of an embodiment that may be used to treat plantar fasciitis through plantar fascia release, reference is now made to  FIGS. 14A-14C . As can be understood from  FIGS. 14A-14B , an elongated body  40  may be introduced through an introducer  35  into the foot  115  and underneath the plantar fascia  120 . The distal end and proximal end of the elongated body  40  may be coupled to handle member(s) (such as those depicted in  FIG. 7A-8D  or  21 A- 21 G or elsewhere in this disclosure). The distal and proximal ends of the elongated body  40  may be displaced in a cutting or sawing motion thereby releasing the plantar fascia ( FIG. 14C ) and decreasing the inflammation. It can be appreciated that other embodiments disclosed herein in the context of treatments for carpal tunnel syndrome may be adapted to treat plantar fasciitis without departing from the spirit and scope of the disclosure. 
     For a discussion of another embodiment of a system where the elongated body is not required to exit the exit point of the hand, reference is now made to  FIGS. 15A to 15L  which depict a complete system in which the distal end of the elongated body does not exit the palm of the hand. 
       FIG. 15A  illustrates one embodiments of a release system. As can be understood from  FIG. 15A , in one embodiment, the complete system  200  includes a deployment or delivery instrument  205 , a return shaft device  210  and a handle member  50 . The system  200  may also include nerve stimulation equipment or a nerve detection device  500  as described herein. 
       FIG. 15B  illustrates the deployment or delivery instrument  205  wherein an elongated body  40  is shown.  FIG. 15C  illustrates the deployment or delivery instrument  205  wherein the elongated body  40  is shown transparent such that a piston  220  and a cutting member delivery device  222  may be seen. As shown in  FIGS. 15B-150 , and with reference to  FIGS. 15D-15F , the deployment or delivery instrument  205  may include an elongated body  40 , a deployment device handle member  50   a , an actuator  55  and a cutting member delivery device  222 . The elongated body  40  may also be configured to receive a piston  220  therein. The actuator  55  and elongated body  40  may be similar to the same elements as described elsewhere in this disclosure. The cutting member delivery device  222  may be a needle, pin or other appropriate device that can deliver an abrasive suture  255  through the deployment or delivery instrument  205 . The deployment device handle member  50   a  may be similar to one of the handle members  50  as described elsewhere in this disclosure. The cutting member delivery device  222  may be coupled to an abrasive suture, wire or other abrasive material  255  (see  FIG. 15L ). 
       FIG. 15D  illustrates deployment of the cutting member delivery device  222 .  FIG. 15E  is an enlarged view of a distal end  225  of the elongated body  40  wherein the cutting member delivery device  222  and piston  220  are shown prior to engagement of the piston  220  with the cutting member delivery device  222 .  FIG. 15F  is an enlarged view of  FIG. 15E . As can be understood from  FIGS. 15D-15F , as the actuator  55  is displaced towards the handle member  50   a , the piston  220  extends through the elongated body  40  into engagement with (but not coupling with) the cutting member delivery device  222 , thereby pushing the cutting member delivery device  222  beyond the distal end  225  of the elongated member  40  to the exit point in the palm and outside of the palm of the hand. The suture  255  may be passed through the piston  220 . Once the cutting member delivery device  222  has exited the palm, the deployment handle  50   a  is retrieved or withdrawn from the device. 
       FIG. 15G  illustrates the return shaft device  210 .  FIG. 15H  illustrates an enlarged view of a distal end  230  of the device  210  wherein a device pocket  225  is shown.  FIG. 15I  depicts an enlarged view of the distal end  230  of the device  210  wherein the device pocket  225  is transparent such that the cutting member delivery device  222  can be seen.  FIG. 15J  is a top plan view of  FIG. 15H . As can be understood from  FIGS. 15G-15J , the return shaft device  210  may include a handle member  50   b , an elongated body  40   b  and a cutting member delivery device pocket  225  at a distal end  230  of the device  210  ( FIG. 15G ). The handle member  50   b  and the elongated body  40   b  may be as described above. As shown in  FIGS. 15H and 15J , the device pocket  225  is generally cylindrical in shape and includes an axial opening  240  defined therein. The opening  240  is configured to receive the cutting member delivery device  222  and may extend less than the length of the device pocket  225 . The opening  240  may be configured to receive securing devices of various dimensions and the dimensions of the opening  240  can be adapted accordingly. As shown in  FIG. 15I  the distal end  245  and the proximal end  250  of the device  222  are placed into the opening  240 , thereby securing the device  222  within the chamber. The abrasive suture material  255  may be outside of the opening  240 . In some embodiments, the distal end  245  may be placed in the opening  240  first. In some embodiments, the proximal end  250  may be placed in the opening  240  first. In other embodiments, both the proximal and distal ends  250 ,  245  may be placed in the opening simultaneously. 
     With reference to  FIGS. 15D-F , once the device  222  has been delivered outside the palm, the handle  50   a  is retrieved or withdrawn from the hand. The device  210  is introduced when the device  222  is outside the palm. The device  222  is received in the device  210  at the opening  240  and the suture  255  trails outside of the opening  240 . As can be understood from  FIG. 15J , the return shaft  210  is then navigated back through the puncture in the palm, navigated above the TCL and out through the original puncture site near the wrist, thereby “wrapping” the suture  255  around the TCL. 
       FIG. 15K  depicts a suture handle member  215 .  FIG. 15L  illustrates a method of wrapping the suture  255  about the handle member  215 . As can be understood from  FIGS. 15K-15L , the suture handle member  215  may be a solid cylindrical shape and may include two suture receiving slits  260 . A first suture receiving slit  260   a  is configured to receive a first end  255   a  of the suture  255  and the suture is then wrapped around the handle through a second suture receiving slit  260   b.    
     With reference to  FIGS. 15K-15L , in use, once the return shaft device  210  has exited the puncture site in the wrist, the suture material  255  is cut so there are two suture lines (the proximal and distal ends of the suture  255   a ,  255   b ). Each of the suture lines  255  may be attached to a suture handle member  215  as described above. The surgeon now has both ends  255   a ,  255   b  of the suture wrapped around a respective handle  215  and can saw, cut, floss or otherwise release the TCL, thereby decompressing the median nerve. At completion of the procedure, the suture  255  is cut and removed. 
     For a discussion of another embodiment of a system where the elongated body and the introducer do not exit the exit point of the hand, reference is now made to  FIGS. 16A to 16H , which depict a release system in which neither the distal end of the elongated body nor the introducer exit the exit point in the palm of the hand. 
     As can be understood from  FIG. 16A , an introducer  35  is introduced at an entry point  300  in the palm of the hand  10 . The introducer  35  may be a 10-12 GA introducer needle. As shown in  FIGS. 16A and 16B , an elongated body  40  including handle members  50   c ,  50   d  at a proximal end  305  of the body  40  and a window  46  is introduced into the palm of the hand through the introducer  35  and guided under the TCL by a neuro-monitoring system (not shown). In some embodiments, the handle member  50   d  may be an actuator  55 . 
     As indicated in  FIG. 16C , the handle members  50   c ,  50   d  at a proximal end  305  of the elongated body  40  are snapped together or otherwise coupled together, thereby extending the cutting member  45  through an exit point  310  in the palm of the hand  10 . In some embodiments, the cutting member  45  may include a piercing member  315 , such as a needle or a pin to pierce the skin at the exit point  310  in the palm of the hand  10 . Coupling the handle members  50   c ,  50   d  also exposes the cutting member  45  in the window  46  of the elongated body  40 . 
     As shown in  FIG. 16D , the piercing member  315  of the cutting member  45  is received in the handle member  50   e  and the elongated body  40  does not exit the exit point  310  of the hand  10 . As indicated in  FIG. 16E , the introducer  35  is withdrawn from the entry point  300  of the palm of the hand  10 . 
     As can be understood from  FIGS. 16F-16H , the handle member  50   e  is closed about the distal end  312  of the cutting member  45  thereby securing the cutting member  45  within the handle member  50   e . The surgeon may now grasp the handle members  50  and can saw, cut, floss or otherwise release the TCL, thereby decompressing the median nerve. 
     As shown in  FIGS. 16F-16H , a motion limiting feature  320  is operably connected to the elongated body  40  and operates to hold the introducer  35  in place such that during the TCL release procedure, the introducer  35  will not further puncture the hand. As indicated in  FIGS. 16G and 16H , the motion limiting feature also prevents the distal end of the elongated body  40  from exiting the palm of the hand. Upon completion of the procedure, the handle member  50   e  may be removed, the cutting member  45  may be retracted and the release system may be removed. In other embodiments, the cutting member  45  may be simply “clipped off” and the system removed. 
     For a discussion of another embodiment of a system where the elongated body and the introducer do not exit the exit point of the hand, reference is now made to  FIGS. 17A to 17H , which depict a release system in which neither the distal end of the elongated body nor the introducer exit the exit point in the palm of the hand. 
     As can be understood from  FIG. 17A , which is an isometric view of the system  700 , in one embodiment, the release system  700  may include handle members  50  (also referred to as a proximal handle assembly  765  and a distal handle assembly  830 ), an introducer  35  (also referred to as an introducer assembly  805 ), and a motion limiting feature  320  (also referred to as a shaft lock assembly  820 ). In some embodiments, the proximal handle assembly  765  may also include an elongated body  40  with a window  46  (also referred to as a probe wire assembly  780 ) and a cutting member  45  (portions of a cutting wire assembly  790 ). In some embodiments, the system  700  may include a hand immobilization device, such as a handboard assembly  705  and a drape assembly  750 . In some embodiments, the handboard assembly  705  may also include at least one cavity  714  configured to receive a nerve detection system or a neuro monitoring system  500 . 
     As shown in  FIG. 17B-1 , the handboard assembly  705  includes a baseplate chassis  710 , a handboard flexboard  730  and a drape assembly  750 . The handboard assembly  705  is configured to receive a patient&#39;s hand and to hold the hand steady during a release procedure. The baseplate chassis  710 , the handboard flexboard  730  and the drape assembly  750  may be manufactured as separate pieces and operably connected as indicated in  FIG. 17A  (or as indicated in a different embodiment, shown in  FIG. 18A ). The baseplate chassis  710  may be made of steel or steel alloy or other appropriate material. The handboard flexboard  730  may be made of polypropylene or other appropriate material. The drape assembly  750  may be made of SMS (spunbound-meltdown-spunbound) material (a synthetic blown fabric) or other appropriate material (e.g. other non-woven materials) and the tabs  754  may be nylon Velcro straps or other appropriate material. 
     As indicated in  FIGS. 17B-2  and  17 B- 3 , which show top and bottom isometric views of the baseplate chassis  710 , the chassis  710  has a first end  718  and a second end  720  and is generally rectangular in shape. The chassis  710  may also include pin slots  717 , a first cavity  714  configured to receive a nerve detection system or neuro-monitoring device  500 , a second cavity  722 , a plurality of feet  712  and a plurality of openings  716  configured to selectively receive a foot  712 . The second cavity  722  is configured to receive or at least not hinder the movement of the distal handle of the release system when the system is in use. 
     As shown in  FIG. 17B-2 , in one embodiment, the first end  718  of the chassis  710  includes two first cavities  714  configured to receive a nerve detection system  500 . In other embodiments, there may be a single first cavity or more than two cavities. In some embodiments, the chassis  710  may not include a cavity  714 . 
     As indicated in  FIG. 17B-2 , the chassis  710  also includes pin slots  717  configured to removably receive the ends of the handboard pin  745  once the handboard pin  745  has been assembled with the flexboard  730  (see discussion below with respect to  FIG. 17B-4 ). The second end  720  of the chassis  710  includes six pin slots  717  on each of the left and right sides  724 ,  726  of the chassis  710 . The first end  718  of the chassis  710  includes one pin slot  717  on each of the left and right sides  724 ,  726  of the chassis  710 . The handboard pin  745  may be selectively positioned in any of the pin slots  717  as needed for proper positioning of the hand during a release procedure. In other embodiments, the chassis  710  may include greater than seven slots  717  on each side or fewer than seven slots  717  on each side. In some embodiments, the slots  717  may be located in other positions about the chassis  710 , such as closer to the middle of the respective sides of the chassis  710 . Further, additional embodiments may include other mechanisms for adjusting the position of the components of the handboard. These mechanisms are discussed below with reference to  FIGS. 17B-7A  through  17 B- 11 B. 
     As shown in  FIG. 17B-3 , the feet  712  are generally mushroom-shaped and may be made of rubber or other appropriate material. The feet  712  are removably coupled to the chassis  710 . When operably connected to the baseplate chassis  710 , the feet  712  are configured to hinder or reduce movement of the chassis  710  while the release system is in use. In one embodiment, four feet  712  may be used. In other embodiments, less than four feet or more than four feet may be used. In some embodiments, the feet  712  may be a different shape such as rectangular or oval or other appropriate shape. In some embodiments, the feet  712  may be integrally formed with the chassis  710 . 
     As indicated in  FIG. 17B-3 , the second end  720  of the chassis  710  includes six openings  716  on each of the left and right sides  724 ,  726  of the chassis  710 . The first end  718  of the chassis  710  includes one opening  716  on each of the left and right sides  724 ,  726  of the chassis  710 . A foot  712  may be selectively positioned in any of the openings  716  as needed for balancing of the chassis  710  or to hinder or reduce movement of the chassis  710  during use. In other embodiments, the chassis  710  may include greater than seven openings  716  on each side or fewer than seven openings  716  on each side. In some embodiments, the openings  716  may be located in other positions about the chassis  710 , such as down a center line of the chassis  710 . In some embodiments, the chassis  710  may not include openings  716  such as where the feet  712  are integrally formed with the chassis  710 . 
     As shown in  FIG. 17B-4 , which is a bottom elevation view of the handboard flexboard  730 , the flexboard  730  is generally rectangular in shape and includes a first end  732  and a second end  734 , which generally correspond in width to and generally align with the ends  718 ,  720  of the chassis  710 . The flexboard  730  additionally includes arms  736 ,  738  extending from opposite sides of the flexboard  730 , a flex strip  740 , drape slots  742  and pin openings  744 . 
     As can be understood with reference to  FIG. 17B-1 , the arms  736 ,  738  extending from the flexboard  730  also include drape slots  742  and thus are configured to accept a portion of the drape assembly  750 . As shown in  FIG. 17B-4 , the flexboard  730  also includes drape slots  742  configured to receive a portion of the drape assembly  750 . 
     As shown in  FIG. 17B-4 , the flex strip  740  extends transversely across the flexboard  730  and is configured to allow the flexboard  730  to angle or arc or bend when the flexboard  730  is coupled to the chassis  710 . This bend encourages proper placement and alignment of a patient&#39;s hand during the TCL release procedure (i.e. the patient&#39;s hand moves from flexion to extension). 
     As indicated in  FIG. 17B-4 , and with reference to  FIGS. 17A ,  17 B- 1  and  17 B- 2 , the pin openings  744  are configured to receive a handboard pin  745 . Once the handboard pin  745  is inserted, the flexboard  730  may be removably attached to the chassis  710  in any of the pin slots  717  as needed for proper positioning of the hand during a release procedure. 
       FIGS. 17B-5  and  17 B- 6  depict a bottom isometric view and an exploded view from a top elevation perspective of the drape assembly  750 . As can be understood from  FIGS. 17B-5  and  17 B- 6 , in one embodiment, the drape assembly  750  includes a drape body  752  and tabs  754 . The drape body  752  includes a first end  756 , a second end  758  and arms  760 . The drape body  752  is generally rectangular in shape, with generally rectangularly shaped arms  760 , and the width of the drape body  752  at each end  756 ,  758  generally corresponds to the width of the flexboard  730  and the chassis  705 . The drape body  752  may be made of SMS material and the tabs  754  may be nylon Velcro straps. 
       FIGS. 17B-7A  through  17 B- 11 B depict several alternate adjustment mechanisms for adjusting the position of the handboard for proper placement of a hand on the handboard  705 . The adjustment mechanisms may be used with the pin adjustment system described above, or may be used in lieu of the pin adjustment system. In general, any known or hereafter mechanism for incrementally adjusting the placement of the flexboard  730  within the handboard assembly  705  is contemplated and may be integrated into the handboard. The following are merely examples of the many adjustment mechanisms that may be used. 
       FIGS. 17B-7A  and  17 B- 7 B depict a balloon adjustment mechanism for the handboard assembly  705 . More particularly, a series of air-filled sacs, or balloons  705 - 1 , may be located on the baseplate chassis  710  at the second end  720 , adjacent to one end of the flexboard  730 . To adjust the position of the flexboard  730 , one or more of the balloons  705 - 1  may be inflated or deflated with air or other gas. Increasing inflation of the balloons  705 - 1  causes the flexboard  730  to slide along the baseplate chassis  710  so as to increase the height of the flexboard, and decreasing inflation of the balloons  705 - 1  allows the flexboard  730  to slide along the baseplate chassis  710  in an opposite direction so as to decrease the height of the flexboard, the resulting operation brought about by inflation/deflation of the balloons being similar to the pin adjustment mechanism described above to adjust the position of a hand of a patient upon the handboard. 
     In another embodiment, shown in  FIGS. 17B-8A  through  17 B- 8 C, a ratchet adjustment mechanism is utilized on the handboard assembly  705 . The ratchet assembly  705 - 2  is located on the baseplate chassis  710  adjacent to one end of the flexboard  730 . The ratchet mechanism may include a series of teeth  705 - 3  disposed along the surface of the baseplate chassis  710  that align with one or more pawls  705 - 4  on the flexboard  730 . In general, the one or more pawls  705 - 4  engage the teeth  705 - 3  of the ratchet system to hold the flexboard  730  in position. To adjust the placement of the flexboard  730 , the pawl  705 - 4  may engage any of the teeth  705 - 3  as desired. 
     In yet another embodiment of the handboard  705 , shown in  FIGS. 17B-9A  and  17 B- 9 B, a rack-and-pinion adjustment mechanism is utilized to adjust the position of the handboard. The rack-and-pinion assembly  705 - 5  is located on the baseplate chassis  710  adjacent to one end of the flexboard  730 . The rack-and-pinion mechanism  705 - 5  may include a linear rack  705 - 6  with a series of teeth disposed along the linear rack. The linear rack  705 - 6  engages a pinion  705 - 7  device on one end of the flexboard  730 . To adjust the position of the flexboard  730 , the pinion device  705 - 7  may be rotated to cause the pinion to engage the teeth to slide along the rack  705 - 6  until the flexboard is in the desired position. 
     In yet another embodiment of the handboard, shown in  FIGS. 17B-10A  and  17 B- 10 B, a scissor adjustment mechanism  705 - 8  is utilized on the handboard assembly  705 . Similar to the above structures, the scissor assembly  705 - 8  is located on the baseplate chassis  710  adjacent to one end of the flexboard  730 . The scissor mechanism  705 - 8  may include linked, folding supports that engage one end of the flexboard  730 . To adjust the position of the flexboard  730 , the scissor device  705 - 8  may be extended or withdrawn to slide along the baseplate chassis  710  into a desired position. 
     In still another embodiment of the handboard, shown in  FIGS. 17B-11A  and  17 B- 11 B, a screw adjustment mechanism  705 - 9  is utilized on the handboard assembly  705 . Similar to the above structures, the screw assembly  705 - 9  is located on the baseplate chassis  710  adjacent to one end of the flexboard  730 . The screw mechanism  705 - 9  may include a screw device  705 - 10  positioned longitudinally along the base of the baseplate chassis  710 . The thread of the screw device  705 - 10  engages a tab at one end of the flexboard  730  such that, when the screw is rotated, the tab and flexboard slide along the baseplate chassis  710  into a desired position. 
     As shown in  FIGS. 17B-5  and  17 B- 6 , the tabs  754  are generally rectangular in shape and include a drape end  759  and a flexboard end  760 . The drape end  759  of the tabs  754  may be different. That is, tabs  754   a  may include a slightly raised, hollow box  759   a  at the drape end  759 . This slightly raised, hollow box  759   a  is the attachment surface of the tab  754   a . Tabs  754   b  may include a lip  759   b  at the drape end  759 . The lip  759   b  is the attachment surface of the tab  754   b . The tabs  754  may be operably connected to the drape body  752  by velcro or other adhesive, such as glue or tape or by other appropriate attachment features. In some embodiments, the tabs  754  may also include a reference or other informative direction to assist the user in assembling the release system (i.e. connecting the disposable drape body to the flexboard) and/or for securing the patient&#39;s hand to the handboard assembly  705 . 
     The handboard  705  may also include a drape glove  761  that fits over the handboard assembly and acts to keep the assembly sterilized during use. The drape glove  761  is shown in  FIGS. 17B-12A  and  17 B- 12 B. In one embodiment, the drape glove  761  includes adhesive tape  761 - 1  to affix the drape glove to the handboard assembly  705 . 
     Another embodiment of the handboard assembly  705  includes a thumb girdle  757  that secures the thumb of a patient to the handboard assembly. As shown in  FIG. 17B-13 , the thumb girdle  757  includes a sock  757 - 1  that fits over one arm of the flexboard  730  and the thumb of a patient. In addition, a flexible tie string  757 - 2  or other lacing device is attached to the sock  757 - 1  that loops around the opposite arm  738  of the flexboard  730  to secure the thumb to the handboard assembly. In this position, the thumb is abducted to place the transverse carpal ligament in tension to allow for ease of cutting. 
     In use, the handboard assembly  705  is assembled by placing the feet  712  in the desired openings  716  of the chassis  710  and the tabs  754  are operably connected to the drape body  752  and the drape body  752  is operably attached to the flexboard  730  by via the tabs  754  which are received in their respective drape slots  742 . Any or all of these steps may have been previously completed by the manufacturer. The tabs  754  may also be used to secure the patient&#39;s hand to the handboard assembly  705 . The handboard pins  745  are also inserted into their respective openings  744  and the flexboard  730  with drape assembly  750  may now be operably and removably attached to the chassis  710 . In one embodiment, the ends  734 ,  720  are attached first to allow the user to determine the desired angle at which to bend the flexboard  730  at the flex strip  740 . The angle or arc is determined based on the desired flexion of the hand. Once the desired angle is found, the other end  732  of the flexboard  730 , with drape assembly  750  attached, may now be operably and removably attached to the slots  717  at the end  718  of the chassis  710 . 
     As can be understood from  FIG. 17C-1 , which depicts the proximal handle assembly  765  in a non-deployed state, the handle assembly  765  includes a handle  770  having a slider channel  769 , a probe wire assembly  780  and a cutting wire assembly  790 . The handle may be made of polycarbonate or other appropriate material. As shown in  FIGS. 17C-2  and  17 C- 3 , which depict a partially exploded view of each side of the proximal handle assembly  765 , the handle  770  includes a slider end  771 , a probe end  772 , a saw wire channel  773  extending axially through the handle  770 , ball detent openings  774 , ball detents  775 , female fastening members  776  and male fastening members  777 . Female fastening members  776  are configured to receive male fastening members  777 , thereby joining each side of the handle  770 . Additional fastening members (not shown) such as screws or pins may be used to further secure the female and male fastening members  776 ,  777 . In some embodiments, the handle assembly  765  may also include wiring (nerve wire assembly  850  and see  550  on  FIG. 18 ) configured to electrically couple components of the handle assembly  765 , such as the probe wire assembly  780 , with a neuro-monitoring or nerve detection device  500 . 
     As indicated in  FIGS. 17C-2  and  17 C- 3 , the cutting wire assembly  790  includes a needle saw wire  792  and a needle saw wire slider  794 . The saw wire  792  and saw wire slider  794  may be made of steel, a steel alloy or other appropriate material. The needle saw wire  792  includes a slider end  796  and a distal end  797 . The slider end  796  of the needle saw wire  792  is coupled to the slider  794  by laser welding or other appropriate method. The needle saw wire slider  794  provides a gripping or pushing surface by which the user can extend and retract the needle saw wire  792  from a non-deployed to or from a deployed state. The saw wire channel  773  extending axially through the handle  770  is configured to receive the saw wire  792  as it extends through the handle as the slider  794  transitions from a non-deployed state (see  FIG. 17C-1 ) to a deployed state (see  FIG. 17H ) and back to a non-deployed state. 
     As can be seen in  FIG. 17C-2 , the slider  794  includes an opening  795  configured to receive the ball detents  775 . As indicated in  FIGS. 17C-2  and  17 C- 3 , the ball detent openings  774  are configured to receive ball detents  775 . The ball detents  775  extend into the slider channel  769  of the handle  770  to hinder or restrict movement of the needle saw wire slider  794  once it is positioned in a non-deployed state ( FIG. 17C-1 ) or fully deployed state ( FIG. 17H ). 
     As shown in  FIG. 17C-4 , which is an enlarged view of the distal end  797  of the needle saw wire  792 , the needle saw wire  792  includes a tissue cutting member  798 , such as a plurality of teeth  798 , a penetration tip or piercing member  799  and threads or ridges  800 . In some embodiments, the cutting member  798  may be another cutting or abrasive surface or may be the saw wire itself. With reference to  FIG. 17C-1 , the saw wire  792  is configured to be received in the probe assembly  780  and the teeth  798  are configured to be exposed in the window  46  of the probe assembly  780  once the window  46  is properly positioned for a release procedure. In some embodiments, the teeth  798  may be unidirectional. In other embodiments, the teeth may have a shape as disclosed elsewhere herein. The piercing member  799  is configured to puncture the skin in the palm of the hand during a release procedure and, as described in more detail below, is received by the distal handle. The threads  800  secure the needle saw wire  792  in the distal handle during a procedure. 
     As indicated in  FIG. 17C-5 , which illustrates an exploded view of the probe wire assembly, the probe wire assembly  780  includes an elongated body  781  having a window  46  and threads  782 , a bump pin  784  and an elongated body mount  785 . The elongated body  781  is received in the body mount  785 . The mount  785  and the body  781  are coupled by any appropriate method, such as welding. The bump pin  784  is received in the elongated body  781  at approximately the window  46  and hinders or restricts forward movement of the needle  799  and teeth  798  of the needle saw wire assembly  790  when the slider  794  is in a non-deployed position. The threads  782  of the elongated body  781  are configured to receive a motion limiting feature  820 , such as a shaft lock assembly  820 , as described in more detail below. The elongated body  781  may be coated with a non-conductive coating, such as Parylene C or other appropriate material. 
     With reference to  FIG. 17A  and as shown in  FIGS. 17D and 17E , the system may also include an introducer assembly  805  and a motion limiting feature  820 . As indicated in  FIGS. 17D-1  and  17 D- 2 , which illustrate two different embodiments of an introducer assembly, the introducer assembly  805  may include an introducer stylet  807 , a stylet hub  809 , an introducer needle  811  and a needle hub  813 . As shown in  FIG. 17D-1  and with reference to  FIG. 17A , the stylet  807  and the needle  811  are hollow, elongated bodies configured to receive the probe wire assembly  780  and the cutting wire assembly  790 . The needle  811  and needle hub  813  are also configured to receive the stylet  807  and stylet hub  809 . The introducer stylet  807  and stylet hub  809  may be integrally formed (see  FIG. 17D-1 ) or formed separately and subsequently coupled (see  FIG. 17D-2 ). In one embodiment, the stylet hub  809  may be generally rounded and the needle hub  813  may be generally cylindrical (see  FIG. 17D-1 ). In other embodiments, the stylet hub  809  may be generally rectangular and the needle hub  813  may include cylindrical  813   a , rectangular  813   b  and disc  813   c  shaped portions (see  FIG. 17D-2 ). In other embodiments, it can be appreciated that the hubs  809 ,  813  may be any other appropriate shape or combination of shapes. The components of the introducer assembly  805  may be made of stainless steel or a steel alloy or other appropriate material. 
     As shown in  FIGS. 17E-1  to  17 E- 3 , which show an isometric, side elevation and cross sectional elevation of the motion limiting feature, respectively, and with reference to  FIG. 17A , the system  700  may also include a motion limiting feature  820 , such as a shaft lock assembly  820 . In one embodiment, the shaft lock assembly  820  includes a shaft lock  821 , a shaft lock inner portion  822  and a spring (not shown). The components of the shaft lock assembly may be made of stainless steel or a steel alloy or other appropriate material. The spring may be a McMaster PN#9001T22. The shaft lock  821  is generally cylindrical and includes an open proximal end  823 , a closed distal end  824  and an opening  825  configured to receive the probe wire assembly  780  or the introducer needle  811  as detailed herein. The shaft lock inner portion  822  is generally mushroom shaped and includes a disc shaped proximal portion  826  with a closed end  827 , a cylindrical body with an open end  828  and a probe wire assembly opening  829  located in the body and configured to receive the probe wire assembly  780  as detailed above. The lock  821 , inner portion  822  and spring are assembled together (the spring is received in the lock  821  and then the inner portion  822  is received in the lock  821 ) and introduced to the probe wire assembly  780  or the introducer needle  811 . The inner portion is depressed, thereby engaging the spring and aligning the openings  825 ,  829  such that the probe wire assembly  780  or the introducer needle  811  can be engaged. A lip  829   a  in the inner portion  822  engages the assembly  780  or needle  811  and together with the spring, maintains the shaft lock assembly  820  in the desired position. To release the shaft lock assembly  820 , the inner portion  822  is again depressed, thereby aligning the openings  825 ,  829 , and the assembly  820  is removed from the probe wire assembly  780  or the needle  811 . 
       FIGS. 17F-1  to  17 F- 4  depict front and back isometric views and exploded views of those isometric views of the distal handle assembly  830 . As indicated in  FIGS. 17F-1  and  17 F- 2 , and with reference to  FIG. 17A , the distal handle assembly  830  includes a handle  831  which is generally cylindrical in shape and may include some contouring. The handle may be made of polycarbonate or other appropriate material. As shown in  FIGS. 17F-3  and  17 F- 4 , and with reference to  FIGS. 17F-1  and  17 F- 2 , the distal handle assembly  830  also includes a rear button  832 , a linkage arm  833 , a lock cam  834  configured to receive the needle saw wire  792 , a cam pin  835  and a funnel  836  configured to receive the distal end  797  of the needle saw wire  792 . 
     As indicated in  FIG. 17F-3 , a first side  831   a  of the handle  831  also includes internal cavities  837  configured to receive the components of the assembly  830  described above and similarly, and as indicated in  FIG. 17F-4 , a second side  831   b  of the handle  831  also includes internal cavities  837  configured to receive the components of the assembly  830  described above such that the sides  831   a  and  831   b  may be joined or coupled together to form the handle  831 . In other embodiments, the handle  831  is formed as a single piece. 
     As assembled, prongs  832   a  of the button  832  receive a button end  833   a  of the linkage arm  833 , a cam end  833   b  of the arm  833  is received by an arm end  834   a  of the cam  834 . The cam  834  also includes a cam pin opening  834   b  configured to receive the cam pin  835 . The funnel  836  is received in a cavity  837  a and the button is received in a cavity  837   b . As discussed in more detail below, in use, the needle wire  792  of the needle wire assembly  790  enters the handle  831  through the funnel  836  and engages the cam lock  834 , thereby locking the needle in place. To release, the button  832  is depressed, thereby engaging the linking arm  833  and rotating the cam lock  834  to release the needle wire  792 . 
       FIGS. 17G-1  and  17 G- 2  show an isometric and exploded view of a portion of a nerve wire assembly  850 . With reference to  FIG. 17A  and as can be understood from  FIGS. 17G-1  and  17 G- 2 , the nerve wire assembly  850  may be used with a nerve detection system  500  to aid the user in navigating the elongated body  781  in the carpal tunnel region without damaging or contacting nearby anatomical structures, such as nerves, non-target ligaments, etc. The nerve wire assembly  850  may include a female crimp pin  852 , a sheath  854 , a wire  856  and a shrink wrap  858 . In one embodiment, the crimp pin  852  may be a RS232 female contact pin with insulation support, the sheath  854  may be FDA rated polyurethane tubing ⅛″OD 1/16″ID, McMaster PN:5195T616, the wire  856  may be 22 AWG stranded wire with FDA rated insulation and the shrink wrap  858  may be FDA rated heat shrink with adhesive on ID. In some embodiments, the shrink wrap  858  may be a coating on the nerve wire assembly  850  rather than a separate, physical component of the assembly  850 . As assembled, the crimp pin  852  is crimped onto the wire  856 , the sheath  854  slides over the crimp pin and wire, ensuring that the connector slit is visible, yet covers the connector completely. Then, shrink the shrink wrap  858  over the sheath, pin and wire. In one embodiment, in use, the distal end  850   a  of the assembly  850  receives a contact portion (not shown) of a nerve detection device  500  and the proximal end  850   b  of the assembly  850  is received in the proximal handle  770  such that the needle in the proximal handle assembly is electrified and the user is notified when the needle is close to a nerve. 
       FIG. 17H  illustrates the proximal handle assembly  765  and the distal handle assembly  830  operably connected for a release procedure, wherein the hand is not shown for clarity. As can be understood from  FIG. 17H , the needle end  799  of the needle wire assembly  790  punctures the palm and a distal end  797  of the assembly  790  is received in the distal handle assembly  830  (see  FIG. 17H , with reference to  FIGS. 17F-3  and F- 4 ). The threads  800  and needle end  799  at the distal end  797  of the assembly  790  engage the internal components  836 ,  834  of the distal handle assembly  830 , thereby securing the needle wire assembly  790  and the proximal handle assembly  765  together (see  FIG. 17H ). Once the distal end of the needle wire assembly  790  is secured in the distal handle assembly  830  and the shaft lock assembly  805  has been secured to prevent the introducer assembly  805  and elongated body  781  from exiting the palm, the user (surgeon) may use a sawing, cutting or other motion to release the TCL, thereby decompressing the median nerve. (see, for example, FIGS.  9 E and  9 E- 1  showing partial release of the TCL or  FIGS. 16G and 16H ). When the procedure is complete, the button  832  of the distal handle  831  is depressed, thereby disengaging the distal end  797 , including the needle end  799 , of the needle wire assembly  790  from the distal handle assembly  830 . 
     In use, the system  700  may be used as an incisionless technique for releasing the TCL to decompress the median nerve to treat carpal tunnel syndrome. In other embodiments, the system  700  may be used as an incisionless technique for releasing another ligament or anatomical structure to decompress a nerve or other anatomical structure, such as the plantar fascia ligament to treat plantar fasciitis or to decompress the ulnar nerve to treat cubital tunnel syndrome or Guyon&#39;s canal syndrome. With cubital tunnel syndrome, the ulnar nerve is compressed by a bone (the humerus bone). The system could shave down this bone to relieve compression on the nerve. Guyon&#39;s canal syndrome is compression of the ulnar nerve. This compression can be caused by a cyst or an ulnar ligament, e.g. volnar radio-ulnar ligament. 
     As can be understood from  FIGS. 17D-1  and  17 D- 2 , and with reference to  FIG. 5 , the introducer stylet  807  and stylet hub  809  are received in the introducer needle  811  and needle hub  813  of the introducer assembly  805 . As can be understood with reference to  FIG. 17A , the shaft lock assembly  820  may be placed on the assembly  805 . The inner portion  822  of the shaft lock assembly  820  is depressed, thereby engaging the spring and aligning the openings  825 ,  829  such that the needle  811  can be engaged. A lip  829   a  in the inner portion  822  engages the needle  811  and together with the spring, maintains the shaft lock assembly  820  in the desired position on needle  811  such that it does not hinder entry of the assembly  805  into the wrist. The stylet  807  punctures the skin, provides access to the carpal tunnel and prevents coring out of tissue when the introducer assembly  805  is inserted into the deep wrist two to three centimeters proximal to the wrist skin crease and just medial to the palmar longus. Once the introducer assembly  805  is positioned in the deep wrist, the stylet  807  and stylet hub  809  are withdrawn from the introducer needle  811  and needle hub  813  and the needle  811  and hub  813  and shaft lock assembly  820  remain in place. 
     As can be understood from  FIGS. 17C-1  to  17 C- 5 , the needle wire assembly  790  is received in the handle  770  and the probe wire assembly  780 , thereby resulting in the proximal handle assembly  765 . In some embodiments, and with reference to  FIG. 18 , the proximal handle assembly  765  may also be electrically coupled to a neuro-monitoring device  500  via a nerve wire assembly  850  (see the wire  550  of  FIG. 18 ). The nerve wire assembly  850  supplies electrical current to the probe wire assembly  780  such that during insertion of the elongated body  781  into the carpal tunnel, such that contact between the elongated body and a nerve will elicit patient response, e.g. sensory and/or motor. This patient response aids the surgeon in locating the nerve to support safe positioning of the device. As indicated in  FIG. 17A , the proximal handle assembly  765  may then be inserted into the introducer assembly  805  and the shaft lock assembly  820  transitions from the introducer assembly  805  to the proximal handle assembly  765 . The inner portion  822  of the shaft lock assembly  820  is depressed, thereby engaging the spring and aligning the openings  825 ,  829  such that the lock assembly  820  can be removed from the needle  811  and a thread  782  of the probe wire assembly  780  can be engaged. A lip  829   a  in the inner portion  822  engages the thread  782  and together with the spring, maintains the shaft lock assembly  820  in the desired position on the elongated body  781  of the probe wire assembly  780 . With reference to  FIG. 6A , the elongated body  781  of the probe wire assembly  781  is then passed through the carpal tunnel parallel to the nerve and flexor tendons proximal to distal. As shown in  FIG. 17C-5 , the elongated body  781  has a ball tip or blunt probe at a distal end  788  similar to nerve stimulators to prevent impaling the nerve or tendons. Once the assembly  765  has been properly positioned relative to the TCL, with the aid of a nerve detection device  500 , the slider  794  may be advanced from a non-deployed position (see  FIG. 17A ) to a deployed position (see  FIG. 17H ), thereby exposing the cutting surface or teeth  798  of the needle wire assembly  790  in the window  46 . The needle end  799  of the needle wire assembly  790  punctures the palm and a distal portion of the assembly  790  is received in the distal handle assembly  830  (see FIG.  17 H, with reference to  FIGS. 17F-3  and F- 4 ). The threads  800  and needle end  799  at the distal end of the assembly  790  engage the internal components  836 ,  834  of the distal handle assembly  830 , thereby securing the needle wire assembly  790  and the proximal handle assembly  765  together. (see  FIG. 17H ). The shaft lock assembly  805  is repositioned as needed on the thread  782  of the elongated body  781  such that the introducer assembly  805  and the elongated body  781  do not exit the palm. The distal end of the needle wire assembly  790  is secured in the distal handle assembly  830  and the shaft lock assembly  820  is secured to prevent the introducer needle  811  and elongated body  781  from exiting the palm. This reduces the opening or puncture made in the patient&#39;s palm. The user (surgeon) may use a sawing, cutting or other motion to release the TCL, thereby decompressing the median nerve (see, for example, FIGS.  9 E and  9 E- 1  showing partial release of the TCL and  FIGS. 16G and 16H ). When the procedure is complete, the button  832  of the distal handle  831  is depressed, thereby disengaging the distal end  797 , including the needle end  799 , of the needle wire assembly  790  from the distal handle assembly  830 . The distal handle  831  may be placed to the side or discarded. The slider  794  of the proximal handle assembly  765  is refracted from the deployed state into the non-deployed state, thereby withdrawing the cutting member  798  of the needle wire assembly  790  from the window  46 . The shaft lock assembly  820  is disengaged from the elongated body  781  and re-engaged with the introducer needle  811 . The proximal handle assembly  765  is withdrawn from the introducer needle  811  and hub  813 . The introducer needle  811  and hub  813  are withdrawn from the wrist. 
     In some embodiments, the hand may be immobilized in a hand immobilizer system, such as the handboard assembly  705 , thereby reducing the chance of movement of the hand out of its position under the TCL, thereby increasing control of the device during the release procedure. The handboard assembly  705  is assembled as described above to place the hand into a proper position to conduct the procedure. The hand may be initially secured by the tabs  754  and may be further secured by additional straps to further immobilize the hand. 
     For a discussion of another embodiment of a system where the elongated body and the introducer do not exit the exit port of the hand, reference is now made to  FIG. 18 , which depicts a release system in which neither the distal end of the elongated body nor the introducer exit the exit point in the palm of the hand. 
       FIG. 18  illustrates an embodiment with many similar features as described above with reference to  FIGS. 17A-17H . In general, the handboard assembly  705 , the nerve detection/stimulator wiring assembly, the introducer assembly  805 , shaft lock assembly  820 , proximal handle assembly  765  and distal handle assembly  830  are as described above with respect to  FIGS. 17A-17H . As can be understood from  FIG. 18 , the handboard assembly  705  includes comparable elements except only one nerve detection system cavity  714  is shown and the drape assembly  750  does not include tabs. In addition, a nerve detection system  500  is illustrated.  FIG. 18  also illustrates a wire  550  at the proximal end  771  of the proximal handle assembly  765  which may be used with the nerve detection system. The distal handle assembly  830  illustrates a different embodiment of the handle, wherein the shape is similar to the proximal handle and the proximal end with the release button has a slope. The fastening members (e.g. screws) that join the two sides of the handle can also be seen. The embodiment of the system as depicted in  FIG. 18  operates as described above with respect to  FIGS. 17A-17H . 
     As discussed above, the cutting member  45  may extend from or about the window  46  to release the TCL. For a discussion of some embodiments of a cutting member  45  that may be used according to the present disclosure, reference is now made to  FIGS. 19A-19E , which illustrate various additional embodiments of a cutting member  45 . 
     As shown in  FIG. 19A , in one embodiment, the cutting member  45  may be a rotating cutting wire or other rotating abrasive surface. This embodiment of the cutting member  45  is inserted into the elongated body  40  and advanced such that it is exposed in the window  46  once the window is properly positioned under the ligament. The cutting member  45  is rotated like a screw. The rotation of the cutting member  45  within the elongated body  40  can be accomplished by either manual or mechanical energy. The rotating blades or threads  1905  of the cutting member  45  release a ligament  1910 , such as the TCL, plantar fascia or other anatomical structure, to relieve compression of a nerve, such as the median nerve, or other nerve in need of decompression, such as the ulnar nerve. 
     As can be understood from  FIG. 19B , in one embodiment, the cutting member  45  is a hydraulic cutting wire or water jet. The cutting member  45  may include a water delivery body  1915  having a water jet  1920 , and a protective shield  1925 . In use, the elongated body  40  is positioned dorsal to (underneath) the ligament and the water delivery body  1915  including a water jet  1920  and the protective shield  1925  are advanced to the window  46  of the elongated body  40 . The water jet  1920  is activated (via delivery of water or other appropriate liquid, via the water delivery tube, which may have a water inlet system at a proximal end of the elongated body) and produces a high velocity stream of water that cuts the TCL through a precise and controlled release. It can be appreciated that in other embodiments, the water delivery body  1915 , water jet  1920  and/or the protective shield  1925  may be integrated with the elongated body  40  rather than being separate or individual pieces. 
     As shown in  FIG. 19C , in one embodiment, the cutting member  45  may be a spring assisted-reciprocating cutting member. The cutting member may be a wire or other abrasive material. In this embodiment, the elongated body  40  includes a spring feature  1930  in the distal end  1935  of the body  40 . In use, the elongated body  40  is positioned dorsal to (underneath) the ligament and as the cutting member  45  is advanced distally, the cutting member  45  engages the spring feature  1930 , thereby causing a reciprocating cutting motion in the proximal direction to release the TCL. This spring feature  1930  is included in the elongated body  40  and is compatible with a number of different embodiments of the cutting member  45  as disclosed herein. 
     As can be understood from  FIGS. 19D-1  to  19 D- 3 , in one embodiment, the cutting member  45  may be a circular cutting wire  45 . The cutting member  45  may be a stand-alone cutting member  45  or may be inserted into the elongated body  45  and the teeth  1940  may be exposed in the window  46 . As shown in  FIG. 19D-1 , the cutting member  45  may include a body  1945  having a proximal end  1946  and a distal end  1947 . The proximal end  1946  includes a handle feature  1950  and an actuation mechanism  1955 . As indicated in  FIGS. 19D-2  and  19 D- 3 , the actuation mechanism  1955  releases a cap  1960  at the distal end  1947  of the body  1945  via a linking bar  1961 , thereby exposing the teeth  1940  or other abrasive surface of the cutting member  45 . That is, as actuation mechanism  1955   b  is retracted proximally, the cap  1960  is extended distally and actuation mechanism  1955   a  is extended distally, thereby creating a reciprocating or circular-like sawing or cutting motion such that the teeth  1940 , which may form a “bow” shape, and which may be exposed in the window  46  (not shown), can release the TCL. 
     As shown in  FIGS. 19E-1  and  19 E- 2 , in one embodiment, the cutting member  45  may be a cutting wire  1965  utilizing RF energy. An RF energy device (not shown) may be operably attached to the cutting wire  1965  and the device may be located at a proximal end of the elongated body  40 . As shown in  FIG. 19E-1 , once the elongated body is properly positioned, the cutting wire  1965  is advanced through the elongated body  40  to the window  46 . As shown in  FIG. 19E-2 , the cutting wire  1965  is advanced through the window  46 . The RF energy device provides RF energy to the cutting wire  1965  in a controlled and directed manner in order to release the ligament  1910 . 
     For a discussion of various embodiments of a nerve detection system or neuro monitoring system  500 , reference is now made to  FIGS. 20A-20F , which illustrate various embodiments of a nerve detection system that may be used with a release system as disclosed herein. In embodiments which utilize a nerve detection system, the nerve detection system helps to enable the release system to be a “closed release system” or an incisionless system because the user can safely navigate the release system within the carpal tunnel region and surrounding areas without making an incision. 
     As discussed above, the elongated body  40  may have neuro monitoring features, such as a supple metal probe, that may be used in conjunction with neuro monitoring systems or nerve detection systems  500  to help guide the elongated body  40  through the carpal tunnel area without harming nearby nerves and such that the body  40  is properly positioned under the TCL. In some embodiments, the neuro monitoring system  500  may be the system offered by Cadwell Laboratories, Inc., Kennewick, Wash., Biotronic, Ann Arbor, Mich. or Medtronic, Minneapolis, Minn. (such as the Vari-Stim III Nerve Locator). The supple metal probe, such as the blunt probe tip  42 , is also attached to a nerve monitor to assist the surgeon in navigation under the TCL. It can be appreciated that the probe may also be a separate instrument from the elongated body. The surgeon can identify median nerve irritation and accordingly alter the course of the body  40  with hand movements or remove the body  40  and start over again. 
     As shown in  FIG. 20A , in one embodiment, the nerve detection system  500  is a nerve locating device. This device  500  is a nerve locating system that is placed external to the patient&#39;s hand  10  and includes a nerve stimulator  2005  and a visualization device  2010 , which may be a screen, monitor or other appropriate device. Stimulation is applied by the stimulator  2005  to the nerves  2015  and the device  500  detects magnetic fields from the nerves  2015  and translates them into a lighted mapping of the nerve location, which is shown on the visualization device  2010 . That is, the nerves  2015  are stimulated using an external electrical current such as a surface electrode which creates an increased electrical signal in the nerves. The device then detects the signal and enables a visual mapping of the nerves. An elongated body  40  of a release system as disclosed herein may be inserted through an introducer  35  and deployed at a safe distance from the nerves as determined by looking at the nerve location on the visualization device  2010 . 
     As indicated in  FIGS. 20B-1  to  20 C, in some embodiments, the nerve detection system  500  is or includes a durometer or other similar hardness tester  2020 . The durometer  2020  may include a pin  2021 , a spring  2022  and a force sensor  2023 . The durometer  2020  measures variations in material hardness and, accordingly, can detect or identify the differences in hardness of anatomical structures  2030 , such as nerves  2015 , ligaments  2025 , tendons, bones, or etc. As shown in  FIGS. 20B-2  and  20 B- 3 , the durometer  2020  may be operably connected to or axially extend from a distal end of the elongated body  40 . As shown in  FIG. 20C , a plurality of durometers  2020  may be operably connected or extend transversely from a distal end of the elongated body  40 . 
     One or more durometers  2020  may be operably connected to the elongated body  40  and can detect if the body  40  comes in contact with a nerve  2015  or other anatomical structure  2030 . As shown in  FIG. 20B-2 , in a non-compressed (pre-contact) state, the spring  2022  is in an expanded state. As indicated in  FIG. 20B-3 , if the pin  2021  comes into contact with an anatomical structure  2030 , the pin  2021  will compress the spring  2022 , which compression is measured by the force sensor  2023 . Because anatomical structures have varying degrees of hardness (e.g. bones are harder than nerves), the durometer  2020  will help to detect if the elongated body  40  of the release system is being (or will be) inserted too close to a nerve. In such a case, the elongated body  40  may be redirected or reinserted. 
     As shown in  FIG. 20D , in one embodiment, the nerve detection system  500  may be an electromagnetic sensor  2035 . The sensor  2035  is operably connected to the elongated body and can detect proximity to the nerves  2015 . A nerve conveys information in the form of electrochemical impulses (known as nerve impulses or action potentials) carried by the individual neurons that make up the nerve. The detection by the sensor  2035  is accomplished by sensing differences in electromagnetic fields emanating from the nerves and may offer a warning, e.g. a signal, that contact with a nerve is imminent. This detection allows the surgeon to reposition the elongated body  40  without coming in contact with the nerve. 
     As indicated in  FIG. 20E , in one embodiment, the nerve detection system  500  may be an ultrasound probe  2040  and associated visualization device  2045 , which may be a screen, monitor or other appropriate device. The probe  2040  is integrated with the elongated body  40  of the release system to enable ultrasound imaging within the carpal tunnel  5  and hand. The probe  2040  operates like a traditional ultrasound transducer but is sized to be compatible with the elongated body  40  and the release system. As the surgeon is advancing the system within the carpal tunnel, the ultrasound probe  2040  will transmit images to the visualization device  2045  and the surgeon can advance or alter the course of advancement of the elongated body  40  in order to avoid contact and/or injury of neural and vascular structures. 
     As shown in  FIG. 20F , in one embodiment, the nerve detection system  500  may be a catheter  2050  with nerve stimulation contact points  2055 . The catheter  2050  may be a steerable catheter that is advanced through the elongated body  40 . In one embodiment, the catheter  2050  is advanced through the elongated body  40  while the cutting member  45  is not assembled within the elongated body  40 . The catheter  2050  can be directionalized and advanced toward suspected nerve location(s) in order to identify the location(s) and direct the elongated body  40  away from such location. The catheter  2050  exits through the window  46  of the elongated body  40  and the catheter  2050  may be removed once the elongated body  40  is properly positioned in the carpal tunnel area as described elsewhere herein. 
     The embodiment shown in  FIGS. 22A-1  and  22 A- 2  includes a trigger grip handle  2200  connected to the tubular body  40  at the proximal end. The cutting member  45  of the release system is located at least partially within the tubular body  40 . In addition, through an actuator  2202  or trigger on the handle  2200 , the cutting member  45  and tubular body  40  may be longitudinally displaced from a non-deployed to a deployed position, thereby causing the cutting member  45  to distally extend from the distal end  42  of the tubular body  40 , exposing the cutting member  45  for use in releasing the TCL. Various actuators  2202  and related movement of the tubular body  40  and cutting member  45  are described below with reference to  FIGS. 22B-1  through  22 K- 2 . In general, any of the features of the embodiments described below may be combined in any combination for a release system. Further, in use, the tubular body  40  is introduced into the carpal tunnel with the cutting member  45  in the non-deployed position to prevent damage to the tissue of the hand. Upon proper placement of the tubular body within the tunnel, the cutting member  45  is placed into the deployed position such that the TCL may be cut. 
     As described above, a nerve detector  2201  may be integrated into the release device. In the embodiment shown in  FIGS. 22A-1  and  22 A- 2 , the nerve detector  2201  includes one or more conductors on the distal end  42  of the tubular body  40 . The nerve detectors operate in a similar manner as described above and may be uni-polar or bi-polar. In other embodiments, the nerve detector  2201  is located on the distal end of the cutting member  45 . In yet other embodiments, nerve detectors  2201  are located on both the tubular body  40  and the cutting member  45  and may be in communication to provide the user of the release system an indication of an encountered nerve. The indication of the encountered nerve may be in the form of a visual and/or audio indication that increases in intensity as the proximity to the nerve increases. 
     In one embodiment of the trigger release device, shown in  FIGS. 22B-1  and  22 B- 2 , a trigger grip handle  2204  includes an actuator trigger  2206  that may be pressed by the fingers of a user of the device. When the user presses the actuator  2206 , the tubular body  40  is longitudinally displaced or retracted toward the handle  2204 . In one example, the trigger  2206  is mechanically connected to the tubular body  40  such that longitudinal movement of the trigger by the fingers of the user results in a corresponding longitudinal movement of the tubular body. In addition, the retraction of the tubular body  40  causes the cutting member  45  located within the tubular body to pass through the distal end  42  of the tubular body to expose a cutting surface of the cutting member, placing the cutting member in a deployed position for cutting the TCL. Upon cutting of the TCL, the trigger  2206  may be released to return the tubular body  40  over the cutting member  45  and placing the cutting member in a non-deployed position. In one embodiment, the cutting member  45  may include a point  2208  at the distal end of the cutting member for piercing the palm of the hand, for the procedures explained above regarding cutting the TCL. 
     In another embodiment of the trigger release device shown in  FIGS. 22C-1  and  22 C- 2 , the release device includes the above-described trigger  2206  and a thumb actuator  2212  located on the top surface of the handle  2210  near the thumb of the operator of the device. Pressing the thumb actuator  2212  causes the cutting member  45  to longitudinally displace away from the handle (i.e., displace distally), and pressing the trigger  2206  causes the tubular body  40  to displace in the opposite direction (i.e., proximally). The thumb actuator  2212  may actuate a spring device that displaces the cutting member  45  in a similar manner as described above. The trigger actuator  2206  may operate as described above to longitudinally displace the tubular body  40  toward the handle. Thus, the combined movement of the tubular body  40  and the cutting member  45  in opposite directions in relation to the handle  2210  act to place the cutting member in the deployed position for cutting. 
     In some embodiments, such as those shown in  FIGS. 22D-1  through  22 E- 2 , a rotatable actuator  2216  may be employed on the handle  2214 . For example, in the embodiment shown in  FIGS. 22D-1  and  22 D- 2 , the handle  2214  includes the thumb rotation actuator  2216  that is rotatable by the thumb of the user and is in communication with the tubular body  40  or the cutting member  45 . In one embodiment, rotation of the thumb rotation actuator  2216  causes the tubular body  40  to retract toward the handle. In another embodiment, rotation of the thumb rotation actuator  2216  causes the cutting member  45  to be longitudinally displaced away from the handle. A trigger actuator  2206 , similar to those described above, may also be used in conjunction with the rotatable actuator  2216  to longitudinally displace either the tubular body  40  or the cutting member  45  to expose the cutting member during the procedure. 
     In one embodiment, the thumb rotation actuator  2216  may be in communication to the tubular body  40  and/or the cutting member  45  through a screw device such that rotation of the rotation actuator causes the tubular body and/or cutting member to also rotate in addition to the longitudinal displacement. In other embodiments, the tubular body  40  and/or the cutting member  45  do not rotate when longitudinally displaced. 
       FIGS. 22E-1  and  22 E- 2  depict a similar release device as that described above with a rotatable actuator shown in  FIGS. 22D-1  and  22 D- 2 . However, in this embodiment, the rotation actuator is located at the junction of the tubular body  40  and the handle  2218 . Rotation of the rotation actuator  2220  may result in the same longitudinal displacement of the tubular body  40  and/or cutting member  45  as described above. In an additional embodiment, actuation of the rotation actuator  2220  may occur by the pressing of the trigger  2206  of the handle  2218 . In other words, in this embodiment, the trigger actuator  2206  controls both longitudinal displacements of the tubular body  40  and the cutting member  45  by actuating the rotation actuator  2220  and the trigger actuator simultaneously. 
     In another embodiment, shown in  FIGS. 22F-1  and  22 F- 2 , the cutting member  45  is longitudinally displaced away from the handle  2222  when the trigger actuator  2206  is pressed. This longitudinal displacement orients a cutting surface  2224  of the cutting member  45  within a window  46  of the tubular body  40 , similar to the embodiment described above with reference to  FIGS. 8A-8C . In a similar embodiment, the tubular body  40  may be retracted by actuation of the trigger  2206  to orient the cutting surface  2224  within the window  46  of the tubular body. Upon release of the trigger  2206 , the cutting member  45  may return to a non-deployed position within the tubular body  40  for safe removal of the tool from the hand. The distal tip of the cutting member  45  and the distal end  42  of the tubular body  40  may include electrodes  2201  for sensing the nerves. The distal region of the cutting member  45  can be caused to distally project out of and retract into the distal end  42  of the tubular body  40  via actuation of the trigger actuator  2206 . 
     In a similar embodiment, shown in  FIGS. 22G-1  and  22 G- 2 , longitudinal displacement of the cutting member  45  is activated by the trigger  2206  of the handle  2222  to expose a cutting tooth  2228  through a window  2226  in the tubular member. In this embodiment, the window  2226  may be smaller than in previously described embodiments. The cutting tooth  2228  is biased by a spring device within the cutting member  45  such that when the cutting tooth is aligned with the window  2226 , the cutting tooth is forced through the window. In this deployed position, the cutting tooth  2228  may be used to cut the TCL. In addition, the cutting tooth  2228  may include a concave surface on the proximal edge of the tooth such that, as the cutting member  45  is retracted into the non-deployed position, the concave surface of the cutting tooth  2228  may engage the edge of the window  2226  to counter the spring bias on the cutting tooth and return the cutting tooth to within the tubular body  40 . In this position, the tubular body  40  may be removed from the patient without further cutting of the tissue of the hand. In another embodiment, the trigger  2206  longitudinally displaces the tubular body  40  into the deployed position. In yet another embodiment, both the tubular body  40  and the cutting member  45  are longitudinally displaced by the trigger  2206 . The distal tip of the cutting member  45  and the distal end  42  of the tubular body  40  may include electrodes  2201  for sensing the nerves. The distal region of the cutting member  45  can be caused to distally project out of and retract into the distal end  42  of the tubular body  40  via actuation of the trigger actuator  2206 . 
     In another embodiment, shown in  FIGS. 22H-1  and  22 H- 2 , the trigger  2206  of the handle  2224  activates to open a hinged flap or flaps  2230  on the tubular body  40 . The opening of the flap or flaps  2230  reveals the cutting member  45  for the sawing action, as described above. In one embodiment, the tubular body  40  includes a single flap  2230  that rotatably opens in a clockwise or counter-clockwise direction. In other embodiments, the tubular body  40  includes a plurality of flaps  2230  that open to expose the cutting member  45 . In addition, the flaps  2230  may be configured to provide a physical barrier between the cutting member  45  and the tissues of the hand that are not intended to be cut. For example, the flap  2230  upon opening may press against a nerve or other tissue near the cutting member  45  to provide a physical barrier between the cutting member  45  and the nerve prevent damage to the nerve. The flap  2230  may also physically move certain tissue near the cutting area away from the TCL for further protection when opened. 
     In one embodiment as depicted in  FIGS. 22I-1  through  22 I- 5 , the tubular body  40  may be rotatable about its longitudinal axis relative to the cutting member  45  and/or the cutting member  45  may be rotatable about its longitudinal axis relative to the tubular body  40  so as to expose the cutting features  2225  of the cutting member within a window  2224  of the tubular body  40 . For example, as can be understood from  FIGS. 22I-1  and  22 I- 2 , the window  2224  may be oriented relative to the cutting features  2225  of the cutting member  45  such that the cutting features  2225  are hidden from exposure to tissue by the cylindrical wall of the tubular body  40 . Such a condition is depicted in  FIG. 22I-4 , which is a longitudinal cross section of the tubular body  40  and cutting member  45  with the cutting features  2225  oriented opposite the window  2224  so as to hide the cutting features within the tubular body. 
     As indicated by the rotational arrows in  FIG. 22I-1 , the thumb knob  2216  or similar actuation feature may be rotated to cause rotation of the tubular body  40  about the cutting member  45  and/or cause rotation of the cutting member within the tubular body. Such rotation occurs until the window  2224  is positioned such that the cutting features  2225  are exposed within the window  2224 , thereby allowing the cutting features to be used for cutting tissue. Such a condition is depicted in  FIG. 22I-5 , which is a longitudinal cross section of the tubular body  40  and cutting member  45  with the cutting features  2225  aligned with the window  2224  so as to deploy the cutting features for the cutting of the tissue. When the cutting is complete, the rotation can be reversed to return the cutting features to the non-deployed state depicted in  FIG. 22I-3 . As shown in  FIG. 22I-4 , the distal end  42  of the tubular body  40  may have an electrode  2201  for sensing nerves. 
     In the embodiment shown in  FIGS. 22J-1  and  22 J- 2 , depression of the trigger  2206  of the handle  2232  operates to pull the cutting member  45  toward the handle. However, in this embodiment, the distal end of cutting member  45  is attached to the distal end  42  of the tubular body  40 . In addition, the tubular body  40  is flexible at the distal end  42  and includes a window exposing the cutting member  45  within the window. When tension is created on the cutting member  45  by the depression of the trigger  2206 , the distal end  42  of the tubular body bends laterally, creating a bowstring effect (as seen in  FIG. 22J-2 ) with the cutting member  45  such that the cutting member may be used to cut the TCL. Release of the trigger  2206  returns the cutting member  45  and tubular body  40  to the non-deployed state with the cutting member within the tubular body. 
     In the embodiment shown in  FIGS. 22K-1  and  22 K- 2 , the tubular body  40  and the cutting member  45  may have different contours in the deployed position. More particularly, the cutting member  45  may be flexible such that when the cutting member is in the non-deployed position within the tubular body  40 , the cutting member has the shape of the tubular body. As described above, the tubular body  40  may have a contour or curvature shape to aid in positioning the release device within the carpal tunnel. Similar to the embodiments described above, the handle  2236  may include a trigger  2206  to longitudinally displace the cutting member  45  and/or tubular body  40  into a deployed position. However, in this embodiment, the cutting member  45  has an alternate shape or curvature than the tubular body  40  in the deployed position. For example, the cutting member  45  may have a shape or contour that curves in an alternate direction than the curvature of the tubular body  40 . The alternate curvature of the cutting member  45  may aid in cutting tissue within the hand of the patient. Upon return to the non-deployed position, the flexible cutting member  45  is housed within the tubular body  40  for removal from the patient&#39;s hand. 
     As can be understood from  FIGS. 22K-1  and  22 K- 2 , in one embodiment the tubular body  40  is bowed upward while the cutting member  45  is bowed downward. In other words, cutting member and tubular body are oppositely bowed when the cutting member is fully distally extended from the distal end  42  of the tubular body. An electrode  2201  for sensing nerves may be located at the distal end of the tubular body. 
     In one method of use for the embodiment depicted in  FIGS. 22K-1  and  22 K- 2 , the tubular body can be inserted into the wrist with the cutting member just slightly extending from the distal end of the tubular body, the pointed tip of the cutting member acting as a piercing feature but the cutting member not being so extending from the tubular body distal end that the cutting member is oriented differently from the tubular body. In such a configuration the tubular body and slightly protruding piercing feature can be distally advanced through the wrist until the piercing feature penetrates the palm. A handle can then be attached to the distal end of the cutting member similar to as described above with  FIG. 17H . The cutting member can then be fully extended from the tubular body as shown in bottom picture of  FIG. 22K-1 . As a result, the cutting member will bow upward to create a configuration that enhances the TCL severing capability of the cutting member. 
       FIG. 23  depicts a side-view of an embodiment of the release system conducted with a single puncture through the wrist of a patient. In this embodiment, no puncture is made in the palm of the patient&#39;s hand, thereby reducing the number of cuts in the skin needed for the procedure. Any of the above described embodiments may be configured as single-puncture devices for releasing the TCL to reduce the recovery time needed for the procedure. 
       FIGS. 24A-24E  depict an embodiment of the release system  10  with a braided suture  45  or other cutting member  45  distally terminating in a needle  999  or other penetrating element, the penetrating element  999  being pushed through the wrist tissue via a tubular body in the form of a push rod  45 . As shown in  FIG. 24A , which is a distal/proximal cross sectional elevation of a patient&#39;s wrist, a proximal end of the penetrating element  999  is coupled to the distal end of the cutting member  45 . As indicated by arrow A in  FIG. 24A , the tubular body  40  is used to push the penetrating element  999  through the patient&#39;s wrist, the distal end of the tubular body abutting against the proximal end of the penetrating element in a coupled arrangement. 
     As indicated in  FIGS. 24B and 24C , which are longitudinal cross sectional elevations of the penetrating element  999  and the distal end of the tubular body  40  coupled thereto, in one embodiment, the coupled arrangement between the penetrating element and the tubular body may take the form of a male-female coupling arrangement. For example, as shown in  FIG. 24B , the male-female coupling arrangement between the penetrating element and the tubular body may have a male portion  3333  on the proximal end of the penetrating element  999  and a female portion  3334  on the distal end of the tubular body  40 . Alternatively, as shown in  FIG. 24C , the male-female coupling arrangement between the penetrating element and the tubular body may have a female portion  3335  on the proximal end of the penetrating element  999  and a male portion  3336  on the distal end of the tubular body  40 . 
     As indicated by arrow B in  FIG. 24D , which is the same view as  FIG. 24A , once the penetrating element  999  as been driven through the skin of the palm, the tubular body  40  can be proximally withdrawn from the wrist and from about the penetrating element. As shown by arrow C in  FIG. 24E , which is the same view as  FIG. 24D , the cutting member  45  can then be displaced proximal-distal to sever the TCL. Handles can be coupled to the proximal and distal ends of the cutting member  45  as described above with respect to previously described embodiments. 
     In use, the systems and methods disclosed herein may be used as an incisionless technique for releasing the TCL to decompress the median nerve. In one embodiment, a 14 gauge or similar sized needle introducer is inserted into the deep wrist three or four centimeters proximal to the wrist skin crease and just medial to the palmar longus. An elongated body is then passed through the carpal tunnel parallel to the nerve and flexor tendons proximal to distal. The elongated body has a ball tip or blunt probe similar to nerve stimulators to prevent impaling the nerve or tendons. The distal end of the body (or other associated device, e.g. the sled member) may assume a curled shape such that when it is passed through the ligament towards or into the palm, the tip trajectory is upwards towards the palm skin. A probe is attached to a nerve monitor to assist the surgeon in navigation under the TCL. The surgeon can identify median nerve irritation and accordingly alter the course of the elongated body with hand movements or remove the elongated body and start over again. In various embodiments the elongated body can be at least partially coated with a non-conductive material such that only a portion of the diameter of the body is exposed for nerve stimulation. The elongated body is passed under the TCL to approximately the palm skin between the third and fourth fingers on the medial side of the nerve. The palm skin may be pierced by a sharp wire or stylet inserted through the elongated body (or alternative cutting instrument), the sharp wire extending beyond the blunt tip or probe tip of the elongated body once the probe is identified underneath the skin surface. Alternatively, the ball tip can emit a light that can be identified in the subcutaneous tissues and a small stab wound made to retrieve the probe and deliver it to the surface. Accordingly, the surgeon has passed the elongated body under the carpal tunnel ligament on the ulnar/medial side of the nerve using intraoperative nerve studies to safely navigate through two needle puncture sites. The surgeon may use an embodiment of the elongated body that includes a cutting member or the surgeon may pass other cutting wires or instruments over or through the elongated body for the purpose of cutting the carpal tunnel ligament using a flossing, sawing, cutting or single pull through movement. In some embodiments, the hand may be immobilized in a hand immobilizer system, thereby reducing the chance of movement of the elongated body out of its position under the TCL. 
     Some or all of the various components, e.g., the introducer, elongated body, cutting member, proximal handle assembly, distal handle assembly, etc., may be provided in the form of a packaged kit provided in one or more sterilized, sealed packages from the manufacturer along with instructions provided with the kit or on a website. Some or all of the various components of the kit may be disposable. The instructions provided with the kit or on a website may be assembly instructions related to some or all of the various components of the kit and/or instructions for use of some or all of the components in a release procedure. In one embodiment, a kit for releasing a ligament may include an introducer including a stylet needle, a stylet hub, an introducer needle and an introducer hub. A first handle assembly including: a first handle member, an elongated body including a blunt tip, a window, and a distal end and a proximal end and a cutting member including a piercing member at a distal end of the cutting member may also included. The kit may also include a second handle configured to receive a distal end of the cutting member of the first handle assembly. The kit may also include a motion limiting feature configured to removably couple with the elongated body and/or a handboard assembly, the handboard assembly comprising a baseplate chassis, a fiexboard and a drape assembly. At least some components of the kit may be disposable. 
     All directional references (e.g., proximal, distal, upper, lower, upward, downward, left, right, lateral, front, back, top, bottom, above, below, vertical, horizontal, clockwise, and counterclockwise) are only used for identification purposes to aid the reader&#39;s understanding of the present invention, and do not create limitations, particularly as to the position, orientation, or use of the invention. Connection references (e.g., attached, coupled, connected, and joined) are to be construed broadly and may include intermediate members between a collection of elements and relative movement between elements unless otherwise indicated. As such, connection references do not necessarily infer that two elements are directly connected and in fixed relation to each other. The exemplary drawings are for purposes of illustration only and the dimensions, positions, order and relative sizes reflected in the drawings attached hereto may vary. 
     The above specification and examples provide a complete description of the structure and use of exemplary embodiments of the invention. Although various embodiments of the invention have been described above with a certain degree of particularity, or with reference to one or more individual embodiments, those skilled in the art could make numerous alterations to the disclosed embodiments without departing from the spirit or scope of this invention. Other embodiments are therefore contemplated. It is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative only of particular embodiments and not limiting. Changes in detail or structure may be made without departing from the basic elements of the invention as defined in the following claims.