Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.
Carpal tunnel syndrome is a compression neuropathy of the median nerve as it travels through the carpal tunnel deep to the transverse carpal ligament. This causes paresthesia and pain in the territory of the median nerve and weakness of the thenar muscles depending on the severity of the neuropathy. Paresthesia is most typically in the long/index finger as these nerve fascicles are located on the anterior aspect of the median nerve closest to the transverse carpal ligament. This patient presented with median nerve compression in the forearm and at the carpal tunnel release. A release was performed in the forearm. This video portrays the open carpal tunnel release. Principle points of this surgical technique include an incision ulnar to the thenar crease. This prevents injury to palmar cutaneous branch of the median nerve. In addition, division of the transverse carpal ligament ulnar to the median nerve prevents scarring directly over the nerve. While surgical anatomy can differ from patient to patient, this patient did not have a small palmar cutaneous nerve branching from the ulnar nerve, which can be encountered and easily protected through this incision.
An incision is made ulnar to the thenar crease between the palmar sensory territories of the median and ulnar nerve. In addition, this approach allows for the division of the transverse carpal ligament well away from the median nerve.
- Colbert SH, Mackinnon SE. Nerve compressions in the upper extremity. Mo Med. 2008 Nov-Dec;105(6):527-35. Review. PMID: 19052017.
- Cheng CJ, Mackinnon-Patterson B, Beck JL, Mackinnon SE. Scratch collapse test for evaluation of carpal and cubital tunnel syndrome. J Hand Surg Am. 2008 Nov;33(9):1518-24. PMID: 18984333.
- Ellis RA, Novak CB, Mackinnon SE, Cheng CJ. Workers’ compensation, return to work, and patient satisfaction after carpal tunnel decompression. Am J Orthop (Belle Mead NJ). 2007 Apr;36(4):E63-6. PMID: 17703269.
- Wiesman IM, Novak CB, Mackinnon SE, Winograd JM. Sensitivity and specificity of clinical testing for carpal tunnel syndrome. Can J Plast Surg. 2003 Summer;11(2):70-2. PMID: 24222987.
- Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002 May;18(2):231-41. Review. PMID: 12371026.
- Karpitskaya Y, Novak CB, Mackinnon SE. Prevalence of smoking, obesity, diabetes mellitus, and thyroid disease in patients with carpal tunnel syndrome. Ann Plast Surg. 2002 Mar;48(3):269-73. PMID: 11862031.
- Tung TH, Mackinnon SE. Secondary carpal tunnel surgery. Plast Reconstr Surg. 2001 Jun;107(7):1830-43; quiz 1844,1933. PMID: 11391209.
- Mackinnon SE, Novak CB, Landau WM. Clinical diagnosis of carpal tunnel syndrome. JAMA. 2000 Oct 18;284(15):1924-5; author reply 1925-6. PMID: 11035883.
- Mackinnon SE, Novak CB. Yoga for carpal tunnel syndrome. JAMA. 1999 Jun 9;281(22):2087; author reply 2088-9. PMID: 10367815.
- Hudson AR, Wissinger JP, Salazar JL, Kline DG, Yarzagaray L, Danoff D, Fernandez E, Field EM, Gainsburg DB, Fabi RA, Mackinnon SE. Carpal tunnel syndrome. Surg Neurol. 1997 Feb;47(2):105-14. PMID: 9040809.
- Watchmaker GP, Weber D, Mackinnon SE. Avoidance of transection of the palmar cutaneous branch of the median nerve in carpal tunnel release. J Hand Surg Am. 1996 Jul;21(4):644-50. PMID: 8842959.
- Deune EG, Mackinnon SE. Endoscopic carpal tunnel release. The voice of polite dissent. Clin Plast Surg. 1996 Jul;23(3):487-505. Review. PMID: 8826685.
- Williams TM, Mackinnon SE, Novak CB, McCabe S, Kelly L. Verification of the pressure provocative test in carpal tunnel syndrome. Ann Plast Surg. 1992 Jul;29(1):8-11. PMID: 1497301.
- Cartotto RC, McCabe S, Mackinnon SE. Two devastating complications of carpal tunnel surgery. Ann Plast Surg. 1992 May;28(5):472-4. PMID: 1622022.
- Novak CB, Mackinnon SE, Brownlee R, Kelly L. Provocative sensory testing in carpal tunnel syndrome. J Hand Surg Br. 1992 Apr;17(2):204-8. PMID: 1588205.
- Mackinnon SE, McCabe S, Murray JF, Szalai JP, Kelly L, Novak C, Kin B, Burke GM. Internal neurolysis fails to improve the results of primary carpal tunnel decompression. J Hand Surg Am. 1991 Mar;16(2):211-8. PMID: 2022828.
- Mackinnon SE. Secondary carpal tunnel surgery. Neurosurg Clin N Am. 1991 Jan;2(1):75-91. Review. PMID: 1821736.
- Mackinnon SE, Dellon AL. Anatomic investigations of nerves at the wrist: I. Orientation of the motor fascicle of the median nerve in the carpal tunnel. Ann Plast Surg. 1988 Jul;21(1):32-5. Review. PMID: 3048183.