DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Right hand carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSES:
1. Right hand carpal tunnel syndrome.
2. Flexor tenosynovitis.
PROCEDURE PERFORMED:
1. Microscopic decompression, median nerve, at wrist.
2. Microscopic flexor tenosynovectomy.
3. Microscopic median internal epineurolysis.
SURGEON: John Doe, MD
ANESTHESIA: Local IV sedation.
FINDINGS: Atrophic median nerve and transverse carpal ligament, intact motor branch, and hypertrophic flexor tenosynovium.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old with recurrent carpal tunnel symptoms, positive EMG, who failed attempts at conservative care and presents now for elective carpal tunnel release.
CONSENT: All of the risks were explained preoperatively, and informed consent was given.
DESCRIPTION OF PROCEDURE: The patient was transferred to the operating suite in good and stable condition, placed supine on the operating table and underwent an uncomplicated local IV sedation. The right upper extremity was prepped and draped freely in the usual sterile fashion utilizing Betadine. Following exsanguination with an Esmarch bandage, pneumatic tourniquet was raised to 200 mmHg on the right proximal arm. The skin and median nerve block was performed with 1% lidocaine plain, and the skin and deep subcutaneous tissue injected with 1% lidocaine.
A 2 cm incision distal from transverse volar crease, at the level of the third webspace, was performed sharply. Hemostasis was achieved with bipolar cautery. Meticulous dissection revealed the median nerve distally, paying careful attention to stay on the ulnar aspect of carpal canal. Transverse carpal ligament was transected. Littler scissor was used to transect the remaining proximal fibers of the carpal canal and distal volar forearm fascia was also released. One finger was then passed under the carpal tunnel. Copious irrigation with normal saline was performed. Under high-power magnification with the operative microscope, meticulous median internal epineurolysis was performed and flexor tenosynovectomy was also performed. The motor branch was identified at the parathenar musculature. We did transect the transverse carpal ligament using high-power magnification after Littler scissor was used to transect the remaining proximal fibers. One finger was passed down the carpal canal testing adequate release. We also released some of the distal volar forearm fascia.
Copious irrigation was then performed. A running 4-0 PDS suture was used to approximate the subcutaneous tissues and dermal layers. The skin was augmented using Steri-Strips, Adaptic, 4 x 4s, and a short-arm cast splint was applied. The patient tolerated the procedure well, left the operating room breathing spontaneously in good and stable condition with an intact vascular exam and a persistent median nerve block still in place.
