A Comparison of Histologic and Intraoperative Visual Assessments of Transverse Carpal Ligament During Revision Carpal Tunnel Release

2021 ◽  
Author(s):  
Louis C. Grandizio ◽  
Lisa J. Choe ◽  
Joel C. Klena
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Visual Assessments

Endoscopic Carpal Tunnel Release

2019 ◽  
pp. 989-994
Author(s):  
Antony Hazel ◽  
Neil F. Jones
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Hand Surgery ◽  
Anatomical Landmarks ◽  
Transverse Carpal Ligament ◽  
Palmar Arch ◽  
Endoscopic Carpal Tunnel Release ◽  
Tunnel Syndrome ◽  
Carpal Tunnel Release Surgery ◽  
Open Carpal Tunnel Release

Conventional open carpal tunnel release surgery is one of most successful procedures in hand surgery and has been demonstrated to be an effective treatment for carpal tunnel syndrome. However, a known sequelae in some individuals who undergo the procedure is “pillar” pain. In an effort to avoid this condition and help people return to work more quickly, the endoscopic technique was developed. Endoscopic carpal tunnel release offers a minimally invasive alternative to other traditional techniques with similar outcomes. By placing the incision proximal to the transverse carpal ligament there is potential for decreased scar sensitivity and pillar pain. The technique is technically demanding. The superficial palmar arch and common digital nerve to the ring and middle fingers are at risk for injury during the procedure. With adherence to anatomical landmarks and the proper visualization, the surgery may be safely performed.

scholarly journals Aberrant Positioning of the Ulnar Nerve Found During Carpal Tunnel Release: A Case Report

2019 ◽  
Author(s):  
David R. Veltre ◽  
Kelvin Naito ◽  
Xinning Li ◽  
Andrew B. Stein
Keyword(s):  
Case Report ◽  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Distal Forearm ◽  
Anatomic Variations ◽  
Transverse Carpal Ligament ◽  
Iatrogenic Injuries ◽  
Flexor Retinaculum

Introduction: Aberrant positioning of the ulnar nerve volar to the transverse carpal ligament is a rare anatomic variation.Case Presentation: We present the case of a 55-year-old female with unique ulnar nerve anatomy that was discovered introperatively during carpal tunnel release.  The ulnar nerve was running directly adjacent to the median nerve in the distal forearm and as the median nerve traversed dorsal to the transverse carpal ligament (flexor retinaculum) to enter the carpal tunnel the ulnar nerve continued directly volar to this structure before angling towards Guyon’s Canal.  The unique ulnar nerve anatomy was successfully identified, carefully dissected and managed with a successful patient outcome.Conclusion: Variations of the anatomy at the level of the carpal tunnel are rare but do exist.  Awareness of these anatomic variations and adequate visualization of the ulnar nerve along with the surrounding structures is crucial to avoid iatrogenic injuries during carpal tunnel release. 

Two-portal endoscopic carpal tunnel release surgery: report of early experience

1997 ◽  
Vol 3 (1) ◽  
pp. E7 ◽  
Author(s):  
Cynthia B. Piccirilli ◽  
Christopher I. Shaffrey ◽  
Jacob N. Young ◽  
LaVerne R. Lovell
Keyword(s):  
Learning Curve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Early Experience ◽  
Prospective Analysis ◽  
Transverse Carpal Ligament ◽  
Steep Learning Curve ◽  
Endoscopic Carpal Tunnel Release ◽  
Carpal Tunnel Release Surgery ◽  
Very High

Endoscopic carpal tunnel release is increasingly performed to treat median nerve entrapment neuropathy at the transverse carpal ligament. Proponents of these procedures claim that there are early postoperative advantages to be gained by the patient in the form of decreased pain and weakness, thus facilitating an earlier return to function. However, serious complications associated with the use of these techniques have been reported, especially during the surgeon's purported initial steep learning curve. A prospective analysis of the authors' first 51 cases using a two-portal endoscopic technique was conducted to determine whether these learning curve complications occurred. The authors did experience a learning curve; however, it was not significant. They encountered no serious complications and patient satisfaction was very high. It is concluded that the procedure is relatively easy to learn and safe to perform.

Stiffness of the Transverse Carpal Ligament Under the Influence of Collagenase

2011 ◽  
Author(s):  
Ryan K. Prantil ◽  
Tracy A. Mondello ◽  
Suk H. Yu ◽  
Khurram Pervaiz ◽  
Savio L-Y. Woo ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Geometrical Model ◽  
Sectional Area ◽  
Transverse Carpal Ligament ◽  
Cross Sectional ◽  
Peptide Bonds ◽  
Stiffness Reduction ◽  
Operative Complications ◽  
Tunnel Syndrome

Forming the palmar roof of the carpal tunnel, the transverse carpal ligament (TCL) continues to be the surgical target for carpal tunnel release which aims to relieve the symptoms of patients with carpal tunnel syndrome. However, the surgical procedures may cause several biomechanical and anatomical problems for the carpal tunnel [1]. Therefore, an alternative, aimed at preserving the TCL, might alleviate patients’ post-operative complications. Using a geometrical model, Li et al. showed that the cross-sectional area of the carpal tunnel can be effectively increased by TCL elongation [2]. Theoretically, stiffness reduction could facilitate a ligament’s capability to elongate. Past studies have shown that the utilization of the collagenase enzyme altered the mechanical properties of a soft tissue [3, 4]. It also has been used to treat Dupuytren’s Contracture [5] because collagenase breaks the peptide bonds within collagen fibers [6]. The usage of collagenase could effectively reduce the stiffness of the TCL allowing for the ligament to elongate and for the median nerve to decompress. Thus, the purpose of our study is to determine the effect of collagenase on the stiffness of the TCL. We hypothesize that the stiffness of the ligament will progressively decrease due to the enzymatic effect of collagenase.

scholarly journals Report of a Transligamentous Ulnar Nerve Sensory Branch

Hand ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. NP11-NP13
Author(s):  
Christina R. Vargas ◽  
Kyle J. Chepla
Keyword(s):  
Median Nerve ◽  
Ulnar Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variation ◽  
Dominant Male ◽  
Transverse Carpal Ligament ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Right Hand

Background: Several anatomical variations of the median nerve recurrent motor branch have been described. No previous reports have described the anatomical variation of the ulnar nerve with respect to transverse carpal ligament. In this article, we present a patient with symptomatic compression of the ulnar nerve found to occur outside the Guyon canal due to a transligamentous course through the distal transverse carpal ligament. Methods: A 59-year-old, right-hand-dominant male patient presented with right hand pain, subjective weakness, and numbness in both the ulnar and the median nerve distributions. Electromyography revealed moderate demyelinating sensorimotor median neuropathy at the wrist and distal ulnar sensory neuropathy. At the time of planned carpal tunnel and Guyon canal release, a transligamentous ulnar nerve sensory common branch to the fourth webspace was encountered and safely released. Results: There were no surgical complications. The patient’s symptoms of numbness in the median and ulnar nerve distribution clinically improved at his first postoperative visit. Conclusions: We have identified a case of transligamentous ulnar nerve sensory branch encountered during carpal tunnel release. To our knowledge, this has not been previously reported. While the incidence of this variant is unknown, hand surgeons should be aware of this anatomical variant as its location puts it at risk of iatrogenic injury during open and endoscopic carpal tunnel release.

scholarly journals The Effect of an Open Carpal Tunnel Release on Thumb CMC Biomechanics

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Marc A. Tanner ◽  
Bryan P. Conrad ◽  
Paul C. Dell ◽  
Thomas W. Wright
Keyword(s):  
Carpal Tunnel ◽  
Soft Tissues ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Before And After ◽  
Fresh Frozen ◽  
Rigid Body Mechanics ◽  
Thumb Carpometacarpal ◽  
Open Carpal Tunnel Release ◽  
Cmc Joint

Purpose. We have observed worsening thumb pain following carpal tunnel release (CTR) in some patients. Our purpose was to determine the effect of open CTR on thumb carpometacarpal (CMC) biomechanics.Methods. Five fresh-frozen cadaver arms with intact soft tissues were used. Each specimen was secured to a jig which fixed the forearm at 45° supination, and the wrist at 20° dorsiflexion, with thumb pointing up. The thumb was axially loaded with a force of 130 N. We measured 3D translation and rotation of the trapezium, radius, and first metacarpal, before and after open CTR. Motion between radius and first metacarpal, radius and trapezium, and first metacarpal and trapezium during loading was calculated using rigid body mechanics. Overall stiffness of each specimen was determined.Results. Total construct stiffness following CTR was reduced in all specimens but not significantly. No significant changes were found in adduction, pronation, or dorsiflexion of the trapezium with respect to radius after open CTR. Motion between radius and first metacarpal, between radius and trapezium, or between first metacarpal and trapezium after open CTR was not decreased significantly.Conclusion. From this data, we cannot determine if releasing the transverse carpal ligament alters kinematics of the CMC joint.

Technical Tip for Proximal Release During Open Carpal Tunnel Release Using a Subcutaneous Pocket

2016 ◽  
Vol 21 (02) ◽  
pp. 280-282
Author(s):  
Dariush Nikkhah ◽  
Amir H. Sadr ◽  
Mohammed Ali Akhavani
Keyword(s):  
Carpal Tunnel ◽  
Local Anaesthesia ◽  
Carpal Tunnel Release ◽  
Transverse Carpal Ligament ◽  
Blunt Dissection ◽  
Collective Experience ◽  
Subcutaneous Tissues ◽  
Open Carpal Tunnel Release ◽  
Subcutaneous Plane ◽  
Optimal Visualization

Technical steps to avoid incomplete proximal release of the carpal tunnel are described. Local anaesthesia is infiltrated as a subcutaneous bleb over the distal wrist crease and extending 2–3 cm over the forearm fascia. Tumescence of local anaesthesia into the subcutaneous plane helps create a pocket between the forearm fascia and subcutaneous tissues. Intraoperatively a subcutaneous pocket is made above the transverse carpal ligament and antebrachial fascia with blunt dissection. A retractor is placed under the pocket, which facilitates optimal visualization to allow reliable complete proximal release of compression.The authors have found that this technique is reproducible and reliable across their collective experience.

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