Perioperative management - Karpaltunnelsyndrom – offene Karpaldachspaltung - Handchirurgie
You have not purchased a license - paywall is active: to the product selection
Indications
- Persistent Sensor and/or Motor deficit (hypesthesia, impaired stereoesthesia/2-point discrimination) at 1st to 4th digit with/without thenaratrophy.
- Relevant and compromising painful dysesthesia at 1st to 4th digit, which has not improved under conservative measurement
- in pregnant patients with persistent neurological compromise, in postpartum persistent CTS
Contraindications
- Local or general conditions that are surgically or anesthesiologically inconsistent with elective surgery or are amenable to preoperative improvement
- No specific contraindications in open carpal tunnel release
Preoperative diagnostic work-up
- Typical symptoms:
– Nocturnal burning, tingling or dysesthesia of the four radial fingers
– Hand clumsiness at night or under use - – improves with shaking of the hand
- Clinical examination:
– Inspection/Palpation of the thenar eminence (M. abd. poll. brevis, M. opponens pollicis, M. flexor poll. brevis Caput
profundum) compared to the healthy side, impaired perspiration
– Testing the sensitivity with a cotton swob
– Testing the stereoesthesia via 2-point-diskrimination, recognizing coins or paper clips
– Motor test (abduction, opening a bottle)
– Provocation test: Phalen-Test, Hoffmann-Tinel-sign - Electrodiagnostic testing (always bilateral and ulnar plus median nerve together). Main sign: reduced nerve conduction velocity of the median nerve caused by demyelisation:
– pathological distal motor latency (DML) of the median nerve >4,2ms (and a DML of the ulnar nerve of<3,3ms) - pathological sensitive nerve conduction velocity median nerve <46,9m/s , and a difference of >8m/s compared to the ulnar nerve (reference 44,6m/s)
– reduced amplitude due to the axonal damage - Optional diagnostic tools:
– Diagnostic imaging (X-ray, US, MRI) in case of comorbidities (e.g., carpus, tumor)
- Typical symptoms:
Special preparation
- No special preparation necessary
- Basically, outpatient intervention
- Clarify: contraindication for tourniquet (e.g., hemodialysis fistula)
Informed consent
- Consent about open vs. endoscopic procedure.
– Complication rate open 2,8%, endoscopically 5,6% - Consent about additional procedures e.g., tenosynovectomy
- General surgical risks (wound healing disturbance)
Special surgical risks:
- Damage median nerve (risk for complete section <0,3%) and neuropathic pain
- hypersensitive scar (usually subside after 6 months)
- persistent symptoms, revision surgery
- no recovery of the sensomotor deficit
- recurrence (more frequent in rheumatoid patients)
- wound infection (deep infection <0,5%)
- Tendon-/Vessel damage(extremely rare <0,1%)
- impaired function wrist/hand CRPS (extremely rare)
- Consent about open vs. endoscopic procedure.
Anesthesia
Positioning
Operation room setup
Special instruments and fixation systems
Postoperative management
webop-Account Single
full access to all lectures
price per month
for the modul: hand surgery