Open Carpal Tunnel Syndrome release is discussed in the following sequence.
Standard treatment for CTS
The safe zone of incision is in the line of the long axis of the ring finger
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A skin incision of 1-1.5 inches long over the transverse carpal ligament
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Just distal to the distal wrist crease
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Ulnar to Palmaris longus tendon
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Extending up to the line drawn along the abducted thumb
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Exposure to the fine transverse fibers of the flexor retinaculum
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Palmar cutaneous nerve should be protected
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A sharp #15 knife is used to cut the flexor retinaculum
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Exposing median nerve protected by filmy covering fascia
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After the nerve begins to bulge through the opening
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Freer elevator is inserted distally between nerve and flexor retinaculum
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A sharp tenotome is slid along the flattened upper surface of the elevator
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Retinaculum is cut
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Similarly, the proximal part of the retinaculum is divided
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Tenotome is withdrawn, the dissector is raised to ensure that there is no residual constricting band
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A recurrent branch of the median nerve is identified and released if necessary
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The wound is sutured and POP is applied (splint)
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Hence, Carpal Tunnel Syndrome release is done and
Post operatively, the band is elevated and finger movements are encouraged immediately.
