Carpal Tunnel Flashcards
(25 cards)
What are the key principles of carpal tunnel release?
Complete incision and release of the transverse carpal ligament, while preserving the median nerve and neurovasculature of the hand.
What is the purpose of preoperative preparation in carpal tunnel release?
Confirmation of diagnosis, aided by EMG studies.
What local anaesthetic is used for carpal tunnel release?
Marcaine 0.5%.
What is the recommended position for the patient during carpal tunnel release?
Arm out, on an arm board.
What are the four steps of the carpal tunnel release procedure?
Incision, exposure, dissection and resection, closure.
What are the landmarks for the incision in carpal tunnel release?
Kaplan’s line, extending from the radial border of the ring finger to the hook of the hamate at the base of the thumb.
How long is the incision for carpal tunnel release?
Approximately 3cm long.
What is the maximal extent of the incision in carpal tunnel release?
From the wrist crease proximally to Kaplan’s line distally.
What does exposure require during carpal tunnel release?
Dissection through skin and subcutaneous tissue, and the thick palmar fascia to identify the TCL.
What technique is recommended for haemostasis during the procedure?
Use bipolar for haemostasis.
What should be identified during exposure of the transverse carpal ligament?
The proximal and distal extents of the TCL.
What must be avoided during exposure of the carpal tunnel?
Injury to the palmar cutaneous branch of the median nerve and the ulnar nerve in Guyon’s canal.
Describe the dissection and resection step in carpal tunnel release.
Division of the TCL using careful blunt dissection under the proximal aspect. Incise the TCL longitudinally towards the radial border of the wound.
What is the goal of the release during carpal tunnel surgery?
To extend the release distally until the fat pad of the hand is visible and proximally to the wrist crease.
What structures must be protected during the resection of the TCL?
Deep palmar arch arteries and the recurrent muscular branch of the median nerve.
What is required during closure of the carpal tunnel release?
Confirm that the entire TCL has been released to avoid the risk of recurrence.
What suture type is used for closure in carpal tunnel release?
Interrupted horizontal mattress suture using 3.0 nylon.
What type of dressing is recommended postoperatively for carpal tunnel release?
Simple dressing, SoftBan and crepe for 24-48 hours.
What is the postoperative plan for a patient after carpal tunnel release?
The patient should be able to move their wrist and can use a hand splint for comfort. Consider hand physiotherapy as required.
What are the boundaries of the carpal tunnel?
Roof: transverse carpal ligament; Floor: carpal bones (distally trapezium to hamate, proximally scaphoid to pisiform).
What are the contents of the carpal tunnel?
Median nerve, flexor tendons (FDS and FDP), flexor pollicis longus.
What are early complications of carpal tunnel release?
Intraoperative bleeding and nerve injury; early postoperative complications include haematoma/bleeding, infection, nerve injury symptoms, and pain.
What are late complications of carpal tunnel release?
Recurrence due to incomplete release or formation of fibrosis, chronic pain/CRPS.
What does TCL stand for?
Transverse carpal ligament.
