carpal tunnel/ulnar nerve reading procedure

how can carpal tunnel procedures be performed?

open and endoscopically

what are the 2 techniques for a carpal tunnel procedure?

one or two incisions

what is carpal tunnel syndrome?

a condition of the hand in which the median nerve is compressed by the transverse carpal ligament (TCL)

how is decompression of the transverse carpal ligament achieved?

by incising part of the fibrous sheath of the ligament

what drapes are used for a carpal tunnel procedure?

¾ sheet, stockinette, extremity drape, esmarch bandage, and lead hand

what position is used for carpal tunnel release?

supine with affected arm extended on arm table

what anesthesia is used for carpal tunnel release?

local, regional, or general

what area is prepped for carpal tunnel release?

from tourniquet to fingertip

where is the incision made for a carpal tunnel release?

small incision made on the palmar surface of the hand at the crease of the wrist with a 15 blade on 3 NH

how is the TCL stretched or cut?

a curved mayo or Metz scissors

what are complications of a carpal tunnel release?

median nerve damage and wound infection

where are the incisions created for an endoscopic carpal tunnel release?

1st incision (proximal incision) 1 to 2 cm proximal to the distal wrist crease in the volar midline, 2nd incision on the palm is made in line with the 3rd web space

how is the TCL freed from underlying tissue during an endoscopic carpal tunnel release?

with a synovial elevator

what is used to cut the TCL in an endoscopic carpal tunnel release?

hook knife

the ulnar nerve travels through a tunnel of tissue called what?

cubital tunnel

what is the epicondyle of the elbow commonly referred to as?

the funny bone

as the ulnar nerve enters the hand it travels through a tunnel known as?

guyon’s canal

what is the ulnar nerves function?

gives feeling to the little finger and half of the ring finger, it also controls most of the small muscles in the hand that help with fine movements, and some of the muscles in the forearm that create a strong grip

what are 2 procedures that can relieve ulnar nerve pain?

ulnar nerve decompression and ulnar nerve transposition

ulnar nerve decompression

accomplished by cutting the ligament of Osborne where the nerve passes through the medial aspect of the elbow

ulnar nerve transposition

relocating the ulnar nerve to a slightly more anterior location in the elbow

where is an incision made for a ulnar nerve transposition?

a long incision is made over the ulnar nerve

how is the tissue surrounding the ulnar nerve dissected away?

Metz scissors and crile hemostatic forceps

what is used to aid in handling the segment of the nerve until satisfactory length has been freed?

umbilical tapes (moistened), vessel loops, or Penrose tubing

where is the ulnar nerve transposed beneath?

the fascial flap overlying the medial epicondyle of the humerus which is cut and elevated