This is the video short form for carpal tunnel release. And here's the table of contents for the various aspects of our how to do our carpal tunnel release. My incision is very ulnar to the thenar crease. It's long and it's ulnar to the thenar crease. And it's ulnar to the thenar crease for several reasons. One is I want to be way away from the palmer cutaneous branch of the median nerve. I want any healing to be way away from the median nerve itself. And by coming ulnar I achieve both of those goals and also in many patients if not most patients there's a small cutaneous branch coming off the ulnar nerve and it's large enough to protect through this ulnar incision. It's about two and a half to three and a half centimeters distal to the wrist crease. This incision also lets me see the V between the hypothenar and thenar muscles. And that cues me as to where the termination of the carpal ligament release is. This is a thin woman. I don't need to go above the wrist on her. But on some patients that are obese or have very thick hands, knowing about the distal marker for the V and being able to extend the incision above the wrist is also very helpful. Now it's about in here where you would see that cutaneous nerve branch coming off the ulnar nerve. And I'm not seeing it in this patient but I'm looking for it. I'll frequently open up Guillain's Canal not necessarily because I think I need to open up Guillain's Canal but because it lets me see the V for the hypothenar and thenar. Of course when you do a carpal tunnel release by just doing that you are also decompressing Guillain's Canal. So now I'll start to look for the V. And I see the thenar muscles running in the direction of the thenar muscles, the hypothenar muscles in the opposite direction, and that junction between the two is the V. So there's thenar fascia and then over here hypothenar fascia and muscle. And right between the two of them is this one spot where the hypothenar and thenar fascia meets. That's the termination of that carpal release. I've marked it there with that ink dot. So now I'll start proximally. It doesn't really matter if you start proximally or distally but I usually start proximally and I go very slow. I slow down the speed of the surgery now and just scratch through the carpal ligament going very slowly and I'm on the extreme ulnar side of the ligament. I have not had any problem with subluxation or bow stringing of tendons and I'm very ulnar to the median nerve, way away from the palmer cutaneous branch as you can see. And this allows the healing relating to that division of the flexor retinaculum to be way away from the median nerve. Now I'm coming to the end, that V, and I get rid of my knife and I use my tenotomy so I can pick up and slowly just get fascia. You can see that bright yellow fat which means you're at the end of the release and the median nerve is way over there. It's interesting that even though I'm way ulnar to the median nerve, it's very close to the median nerve. So if you're making your incision right on top of the median nerve, I believe you're going to scar down to it. Now I then move to the very end of the table and I'm releasing the antebrachial fascia and or proximal portion of the ligament. I'm the only one that can see this so I position those CEN retractors or small down curve retractors myself and then I tug on that proximal divided end of the flexor retinaculum, I pull it towards myself, so I pull it towards myself, I make sure that the wrist is slightly flexed, not dorsiflexed, and I'm cutting that ligament and antebrachial fascia on the ulnar side so I'm sort of veering away from the median nerve and I'm going very slowly here, no pushing, no blind pushing, and when you get to the end of that ligament and you can see I've got that wrist slightly flexed so I'm moving the nerve down, I'm cutting on top of the tendon right now, and when I get to the very end, everything is under direct vision and I'm the only one that can see as I'm doing this so I make sure I like where the retraction is. When you're done cutting that ligament there's an abrupt drop off so it's not a little slow drop off, you are done when you get to the end of that thick antebrachial fascia and everything is under complete observation. Median nerve is way over there so way away from the overlying cut on the flexor retinaculum. For more information visit www.SurgicalScience.com

carpal tunnel release surgery

ulnar side incision

palmar cutaneous branch

V between hypothenar and thenar muscles

ligament release