carpal tunnel and ulnar nerve

carpal tunnel

median nerve is compressed either by the transverse carpal ligament, a displaced fracture or a ganglion, can be treated by either open or closed methods

how is the carpal tunnel nerve decompressed?

by removing a part of the fibrous sheath of the ligament, bone, or ganglion cyst that is causing the problem

position, anesthesia, skin prep, and draping for an open carpal tunnel procedure?

supine with hand table, local, bier block, or general anesthesia, prep from finger tips to tourniquet, drape ¾ on hand table, stockinette, and extremity drape

where is the incision made for an open carpal tunnel procedure?

palmar surface of hand (15 blade, 7 knife handle)

what ligament is stretched or cut during a carpal tunnel?

transverse ligament

arthroscopic (closed) carpal tunnel release

requires a small scope, 1 or 2 incisions (one at wrist end of the palm, if needed one across the middle of the palm), mosquito for blunt dissection and knife inserted to divide the ligament

how can the ulnar nerve be damaged?

caused by trauma to the elbow, a fracture that divides the nerve, dislocation of the elbow or irritation of an old injury that stretches the nerve, there is sensory loss to the hand and atrophies

where is the ulnar nerve located?

travels through the cubital tunnel that runs under the medial epicondyle

what are the 2 surgical interventions to relieve ulnar nerve pain from damage?

ulnar nerve decompression and ulnar transposition

ulnar nerve decompression

cutting of ligament of Osborne where nerve passes through medial elbow, removes any tissue causing compression

ulnar transposition

relocates ulnar nerve to anterior location in the elbow, typically moved in front of medial epicondyle to prevent it from being pinched or irritated when the elbow is bent

position, anesthesia, and incision for ulnar nerve decompression/transposition

supine, local, regional, or general anesthetic, 3-4 incision made along the elbow

endoscopic ulnar nerve decompression/transposition approach

1 in incision, tunnel under the skin and over the fascia covering the ulnar nerve, speculum inserted to spread the tissue, scope is inserted, long scissors to divide structures that are compressing the nerve