29 Carpal tunnel release: Open
INDICATIONS
Numbness in the median nerve distribution
Positive Tinel sign, positive Durkan test, decreased two-point discrimination (both moving and static)
Positive results on electromyographic (EMG) testing and nerve conduction velocity testing (increased median motor latency)
INTRODUCTION
Carpal tunnel release surgery is one of the most gratifying and satisfactory surgeries done by the hand surgeon. It can provide immediate and lasting relief to patients suffering from pain and disability.
Carpal tunnel release surgery has progressed from very extensive surgeries to short-scar open surgeries and endoscopic approaches. The option chosen is often up to surgeon preference and patient preference, but there are some indications when it is preferable to choose the open approach. Table 29.1 indicates equipment necessary for the procedure. Surgical equipment required in the operating room includes hand surgery table, sitting stools, sterile gloves, sterile drapes, surgical tourniquet with padding and 1010 drape, prep solution (Figure 29.1).
Sterile skin marker Raytech sponges Esmarch bandage #15 scalpel Senn retractors (2) Freer elevator Ragnell retractors (2) Adson forceps (2) Mayo straight scissors Webster needle driver 4-0 nylon suture Xeroform 1 × 8 strip Kerlix wrap (4″) Gauze sponges, sterile (4 × 4) Ace wrap (4″) |