as Rashard dick is and today we'll be
00:04
discussing open carpal tunnel release we
00:08
performed this procedure under Mac with
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local anesthesia here we're cleaning the
00:13
area Mac Mac anesthesia has been applied
00:16
and now an injection is made proximately
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we then insert and again we'll inject
00:26
distally superficially along the area
00:29
where we believe our incision will be
00:30
made we use a mixture of half a quarter
00:36
percent marking in half of 1% lidocaine
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with a total of 10 cc's will then place
00:48
the portion of the fluid in the carpal
00:49
tunnel as well
00:52
now the anatomical landmarks are marked
00:55
here the hook of the hamate Kaplan's
00:58
cardinal line and the radial portion of
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the ring finger all I didn't use for
01:03
identification I like to use the thenar
01:07
crease if possible
01:18
the incision may be extended as needed
01:20
distally here the skin incision is made
01:29
longitudinally the person performing the
01:34
procedure I've found does better if
01:38
they're moving from distally
01:39
approximately sharps and retractors are
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placed and the adipose tissue is
01:46
released on top of the flexor
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retinaculum
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the flexor retinaculum is now identified
01:52
and in size longitudinally as well again
02:02
any excessive adipose is removed now the
02:06
transverse carpal ligament is visualized
02:11
as you can see here and this is entered
02:15
again using sharp section once the
02:23
sheath is entered the compartment is
02:26
entered you should feel a pop and flexor
02:29
tendon should be identified at that
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point in time we then use a scissor to
02:38
then elevate the soft tissues
02:42
superficial to the transverse carpal
02:45
ligament and also to sound the carpal
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tunnel then we'll release the transverse
02:52
carpal ligament approximately with care
02:55
taken to spread and to palpate prior to
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cutting once we feel that we've had
03:04
adequate release proximally will further
03:07
inspect and evaluate the nerve at this
03:09
point in time occasionally the flexor
03:15
retinaculum will be palpable and if
03:19
possible this is released as well
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we attempt to pass the scissor without
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cutting if possible or cutting director
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is realization now distally the
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remaining portion of the transverse
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carpal ligament is released it's
03:38
released until the fat pad is identified
03:41
once complete release is obtained is
03:44
easy to illustrate the free limbs of the
03:46
transverse carpal ligament and now the
03:49
median nerve is identified as well as
03:51
its thenar branch the one is Courvoisier
03:55
irrigated the skin is closed using an
03:58
interrupted mattress type fashion upon
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closure additional local anesthesia is
04:05
used if necessary a soft dressing is
04:09
placed in a three inch ace is applied we
04:14
typically will ask the patient to go to
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therapy within three to five days to
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begin range of motion to assess for any
04:22
possible hang-ups postoperatively and to
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allow the patient to begin their
04:29
therapeutic regimen typically therapy
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only requires one to two visits by
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placing the incision and Athena or
04:40
crease the room the wound is barely
04:42
evident at healing particularly at three
04:45
months