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Carpal Tunnel Syndrome
Updated: Oct 4 2016

Open Carpal Tunnel Release

Preoperative Patient Care
Operative Techniques

Preoperative Plan


Execute surgical walkthrough

  • describe the steps verbally to the attending prior to the start of the case
  • describe potential complications and steps to avoid them

Room Preparation


Surgical instrumentation

  • Loupes recommended


Room setup and equipment

  • standard operative table with hand table


Patient positioning

  • supine position

Superficial Dissection


Mark the incision

  • mark the incision at the intersection of the Kaplan cardinal line and the radial border of the fourth ray ending at the wrist crease


Make incision

  • make incision anywhere along this mark
  • incision needs to be long enough that the proximal and distal aspects of the TCL can be visualized

Expose the TCL


Expose the TCL

  • use a scalpel or scissors to dissect through the subcutaneous fat and palmar tissue
  • the palmaris brevis muscle is often seen superficial to the TCL
  • incise and feather the palmaris brevis muscle from the TCL to allow adequate visualization
  • use a mosquito clamp or Carroll elevator into the carpal canal just deep to the TCL
  • this space defines the undersurface of the TCL and the hamate hook


Visualize the superficial surface of the TCL

  • place a right angle retractor
  • this is placed to protect the critical structures that are located between the skin and the ligament

TCL Release


Release the most ulnar aspect of the TCL

  • identify the most ulnar aspect of the TCL in the canal close to the hook of hamate
  • release the TCL under direct visualization
  • make sure to release proximally and distally
  • use scissors, scalpel or mini meniscotome type beaver blade
  • keep the radial leaflet of the TCL over the median nerve


Release the distal forearm fascia proximally

  • this is a common secondary site of compression


Confirm release of the TCL proximally and distally


Explore Median Nerve to Ensure Decompressed


Check nerve

  • check all areas for possible nerve compression before wound closure

Wound Closure


Superficial wound closure

  • use 3-0 nylon to close skin



  • place in a soft dressing
Postoperative Patient Care
Private Note

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