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.
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Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.