June 20, 2024

Open Carpal Tunnel Syndrome release is discussed in the following sequence.

Open approach for carpal tunnel release
Open approach for carpal tunnel release

Standard treatment for CTS

The safe zone of incision is in the line of the long axis of the ring finger

A skin incision of 1-1.5 inches long over the transverse carpal ligament

Just distal to the distal wrist crease

Open carpal tunnel release

Ulnar to Palmaris longus tendon

Extending up to the line drawn along the abducted thumb

Exposure to the fine transverse fibers of the flexor retinaculum

Palmar cutaneous nerve should be protected

A sharp #15 knife is used to cut the flexor retinaculum

Exposing median nerve protected by filmy covering fascia

After the nerve begins to bulge through the opening

Freer elevator is inserted distally between nerve and flexor retinaculum

A sharp tenotome is slid along the flattened upper surface of the elevator

Retinaculum is cut

Similarly, the proximal part of the retinaculum is divided

Tenotome is withdrawn, the dissector is raised to ensure that there is no residual constricting band

A recurrent branch of the median nerve is identified and released if necessary

The wound is sutured and POP is applied (splint)

Hence, Carpal Tunnel Syndrome release is done and

Post operatively, the band is elevated and finger movements are encouraged immediately.