Carpal Tunnel Syndrome – Open Carpal Tunnel Release

Anatomical orientation by palpation and marking of anatomical landmarks:

• Planning mini-incision with incision line in the extension line middle 3rd/4th finger ray to ulnar insertion of the palmaris longus tendon at the aponeurosis (guiding structure)
• Incision median palm approximately 2-3 cm long (mini-incision) starting approx. 1.0 to 1.5 cm distal to the rascetta
• sharp transection of the subcutis with bipolar coagulation of individual veins
• Exposure of palmar aponeurosis

Tips for Orientation

• Orientation carpal tunnel based on palpable pisiform bone and scaphoid tubercle
• Flexor retinaculum begins at the level of the rascetta
• Orientation course of median nerve between flexor carpi radialis tendons and palmaris longus tendon

Transection of palmar aponeurosis with exposure of flexor retinaculum

• sharp transection of the palmar aponeurosis in longitudinal direction
• Exposure of distal portion of the flexor retinaculum with, if applicable, superficial palmar arch (arterial superficial palmar arch)

Transection of Flexor Retinaculum with Palmar Carpal Ligament

• sharp transection of the distal portion of the flexor retinaculum under direct vision
• exposure of median nerve

Now reposition the operator to the head end of the hand table for better insight into the proximal carpal tunnel

• blunt release of the median nerve from the carpal roof with careful spreading using scissors over the nerve
• completion of the division of the flexor retinaculum proximally with scissors
• division of the palmar carpal ligament with scissors at the ulnar edge of the palmaris longus tendon (guide structure)

Tips

• running the scissors along the carpal roof to check for complete division
• distally, if necessary, exposure of the superficial palmar arch (arterial superficial palmar arch)