Carpal Tunnel Release

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Definition

-  Division of transverse carpal ligament of carpal tunnel to release pressure on median nerve & relieve carpal tunnel syndrome

 

Features

-  Open or endoscopic: long term outcomes nil difference

-  Open:  better anatomical view, less risk of injury 

-  Endoscopic: ? increased complications, less pain post op

-  90% relief of pain

-  Pain, tingling, numbness improve by 6/52

-  Weakness, grip & pinch strength

-  Initially worsen

-  Pre-op levels 3/12

-  Significant improvement 2yrs

-  By 6/12 77% return to normal work

 

Indications

-  Carpal tunnel syndrome

-  Persistent numbness & pain

-  Motor dysfunction w diminished grip or pinch grasp

-  Thenar eminence atrophy

 

Procedure

-  Pre-op

-  EMS to confirm carpal tunnel syndrome

-  Anaesthetic: LA +/- sedation

-  Operation: Open Release

-  Tourniquet

-  Standard or limited incision

-  Standard incision

-   Proximal to Kaplans cardinal line: web space btwn 1st & 2nd fingers & hamate

-   Curvilinear incision towards ulnar side of palm, ulnar to thenar crease

-  Incision not extended prox to wrist crease to avoid flexion contracture

-   Blunt dissection through palmar fascia to transverse carpal ligament

-   Transverse carpal ligament & antebrachial fascia divided longitudinally along ulnar border

-   Median nerve identified deeply in carpal tunnel

-   +/- neurolysis

-   Haemostasis must be achieved prior to closure

-  Limited incision (Small palmar)

-   Proximal to Kaplans cardinal line: web space btwn 1st & 2nd fingers & hamate

-   Curvilinear incision towards ulnar side of palm for 2 – 2.5cm

-   Carpal tunnel tome used

-  Endoscopic

-  Single or dual portal methods

-  Post-op

-  Soft dressing

-  Simple analgesia

 

Complications

-  Incomplete division of transverse carpal ligament & persistent S/S

-  Most common cause of reoperation

-  Nerve injury: sensory +/- motor

-  Vascular injury to superficial palmar arch

-  CRPS