Carpal tunnel syndrome - open carpal tunnel release - general and visceral surgery

Anatomical orientation by palpating and drawing anatomical landmarks:

• Planning mini-incision with incision in the extension line mid-3rd/4th finger ray on ulnar attachment of the palmaris longus tendon at the aponeurosis (lead structure).
• Incision median palm about 2-3 cm long (mini-incision) starting about 1.0 to 1.5 cm distal to the
• Sharp transection of the subcutis under bipolar coagulation of individual
• Identification of the palmar aponeurosis

Advice:

• Identify the carpal tunnel via palpable os pisiforme and tuberculum scaphoidei
• The flexor retinaculum starts at the rascetta
• The median nerve is located between flexor carpi radialis tendons and palmaris longus tendon

Transection of palmar aponeurosis with visualization of flexor retinaculum

• Sharp longitudinal transection of the palmar aponeurosis
• Visualization of the distal part of the flexor retinaculum with superficial palmar arterial arch

Section flexor retinaculum with palmar carpal lig

• Sharp transection of the distal part of the flexor retinaculum under vision
• The median nerve is identified

For a better view into the carpal tunnel, the surgeon should now move to the head end of the hand table.

• By careful blunt dissection with the scissors, the median nerve is released from the carpal roof
• The section of the retinaculum is completed towards proximally by scissor
• Section of the palmar carpal lig with the scissor at the ulnar side of the palmaris longus tendon (guiding structure)

Advice:

• Check with the scissor for complete section of the carpal tunnel
• Identify superficial palmar arterial arch to avoid damage

Identification median nerve, thenar motor branch and flexor tendons

• Visualization and inspection of the median nerve and optionally of the motor branch at the thenar eminence
• Description of the texture of the nerve regarding signs of compression (flattening, color, pseudoneuroma)
• Visualization and inspection of the flexor tendons, optional tenosynovectomy in cases of advanced chronic tenosynovitis

Advice:

• In case of mayor tenosynovitis, the incision should be extended proximally and ulnar to be able to perform a complete synovectomy.

Control of the width or the carpal tunnel by digital palpation

• Advance with the little finger proximally and distally to check for sufficient space

Irrigation, if necessary, drainage insertion and skin suture

• Careful irrigation of the surgical site with e.g., physiological Ringer's solution with final inspection
• If necessary, insert Mini-Redon- or Redon-Drain Ch 8
• Everting skin suture (single button/continuous/intracutaneous, Omni or steristrips if necessary)
• Sterile dressing, elastic compressive bandage
• If necessary, dorsal wrist splint