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

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  • Plan/Incision

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    72-1

    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 palmar aponeurosis

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    72-2

    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
  • Transection flexor retinaculum

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    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 and flexor tendons

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    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.
  • Digital test carpal tunnel

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    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, closure wound

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    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
date of publication: 25.04.2009

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