PROCEDURE: Right carpal tunnel release.
INDICATION FOR PROCEDURE: The patient is a (XX)-year-old woman who has had progressively increasing numbness and tingling in her right hand. She had previously undergone a successful left carpal tunnel release and now wants the same done on the right. The foreseeable risks and benefits of this procedure were thoroughly explained, and all of her questions were answered.
PREOPERATIVE DIAGNOSIS: Carpal tunnel syndrome, right wrist.
POSTOPERATIVE DIAGNOSIS: Carpal tunnel syndrome, right wrist.
SURGEON: John Doe, MD
ASSISTANT: None.
ANESTHESIA: Local with sedation.
ESTIMATED BLOOD LOSS: Minimal.
FLUIDS: 400 mL lactated Ringer’s.
TOURNIQUET TIME: 10 minutes at 250 mmHg.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was brought into the operating room and placed supine on the operating room table. After institution of mild sedation, a preoperative dose of IV antibiotic was given prior to the initiation of the procedure. A tourniquet was placed high on the right forearm, and the right upper extremity was then prepped and draped in the usual sterile fashion.
Approximately 10 mL of local was injected into the surgical site, which started at the distal volar flexion wrist crease and extended roughly in line with the 4th ray. A 15 blade was used to make the incision after the tourniquet was inflated. A sterile Esmarch bandage was utilized to exsanguinate the arm. Bipolar electrocautery was used throughout the case for hemostasis.
The deep transverse carpal ligament was cleaned and identified. A deep 15 blade was used to carefully incise the transverse carpal ligament. This was extended proximally and distally with blunt Littler scissors. Digital palpation demonstrated adequacy of the release. The underlying median nerve was completely intact with no significant hyperemia, but it was compressed from front to back. The wound was copiously irrigated, and closure was initiated.
The transverse carpal ligament was allowed to fall open. The skin was reapproximated with 3-0 Prolene with mattress sutures. A dry sterile hand dressing was applied with blue sling. The patient was awoken from anesthesia and transferred to the recovery room in satisfactory condition without complication.
