Carpal Tunnel

Scenario

A 40 Year old female attends you clinic. She has been waking up in the middle of the night with tingling in her lateral 3.5 fingers. She finds relief by shaking her hand over the side of the bed.

  • Female sex
  • Obesity
  • Pregnancy
  • Hypothyroidism
  • Rheumatoid arthritis
  • Advanced age
  • Chronic renal failure
  • Smoking
  • Alcoholism
  • Repetitive motion activities

Roof – Transverse carpal ligament

Floor – Proximal carpal row (scaphoid, lunate, triquetrium)

Radial border – Scaphoid tubercle and trapezium

Ulnar border – Hook of hamate and pisiform

4 tendons of flexor digitorum superficialis

4 tendons of flexor digitorum profundus

Median nerve

Flexor pollicis longus (most radial structure)

Non operative

  • NSAIDS
  • Night splints
  • Activity modification
  • Steroid injections

 

Operative

  • Carpal tunnel release

In an appropriately marked and consented anaesthetised patient. I would complete the WHO checklist.

Position the patient supine on the table with the arm board.

  • Incision would be from the distal palmar crease no further than Kaplan’s cardinal line (Line between the 1st web space to hook of hamate)
  • Incision would be in line with the radial border of the ring finger.
  • Superficial dissection would be through subcutaneous fat care should be taken to avoid the palmar cutaneous nerve.
  • Place West retractor
  • Incision would be through the transverse carpal ligament to release median nerve. McDonald’s would be used to protect the median nerve.
  • Washout wound.
  • Closure with 4-0 nylon to skin.
  • Wool and crepe bandage.
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