DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSIS: Right carpal tunnel syndrome.
PROCEDURE PERFORMED: Right carpal tunnel release.
SURGEON: John Doe, MD
ANESTHESIA: Local MAC.
ESTIMATED BLOOD LOSS: Minimal.
TOURNIQUET: Right forearm, 275 mmHg, total time 4 minutes.
INDICATION FOR PROCEDURE: This is a (XX)-year-old African-American female who has been complaining of numbness and tingling in the right hand for several years. The patient was diagnosed with carpal tunnel syndrome. She recently underwent EEG, which confirmed the carpal tunnel syndrome with compression of the median nerve at rest. The patient was treated nonoperatively with night splint as well as injections with no relief. All the risks and benefits of the procedure were discussed with the patient, and informed consent was obtained.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. The patient was given local MAC. Ten mL of 0.5% Marcaine was infiltrated at the right carpal tunnel. The tourniquet was placed on the right forearm. The right upper extremity was then prepped and draped in regular sterile routine fashion. An Esmarch was used for exsanguination, and the tourniquet was inflated to 275 mmHg.
A longitudinal incision was made over the carpal tunnel in line of the fourth digit just distal to the rest crease. The superficial palmar fascia was incised. The deep transverse carpal ligament was identified and that was incised with a 15 blade. It was found to be thickened. The transverse carpal ligament was incised distally until the fat pad was seen. Proximally, it was incised with the tenotomy scissors under direct visualization. The median nerve appears to be normal. No other pathology can be seen.
The tourniquet was then deflated, and the wound was irrigated copiously with normal saline. The skin was then closed with 4-0 nylon. Dressing was applied with Adaptic, 4 x 4, and Coban. The patient tolerated the procedure well and was taken to the recovery room in stable condition.
Orthopedic Operative Samples #1
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSIS: Right carpal tunnel syndrome.
PROCEDURE PERFORMED: Right carpal tunnel release.
SURGEON: John Doe, MD
ANESTHESIA: Monitored anesthesia care.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old woman with clinical signs and symptoms of right carpal tunnel syndrome. She had a positive Tinel’s sign over her right hand and EMG evidence of carpal tunnel disease. Having failed conservative management, the patient elected to proceed with the surgical option of carpal tunnel release.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and monitored anesthesia care was administered. The right hand was then prepped and draped in the usual sterile fashion. Lidocaine with epinephrine was then injected into the palmar area along the lifeline crease.
A 1 inch incision was created distally to the wrist crease with a 15 blade knife. The knife was also used to divide the palmaris longus tendon vertically and then to do a partial division underlying transverse carpal ligament. The transverse carpal ligament was then divided proximally and distally using scissors. Excellent decompression of the underlying median nerve was accomplished.
The wound was then irrigated with antibiotic solution. The skin was then closed with interrupted vertical nylon 5-0 sutures. Sterile dry gauze dressing was then applied. The patient was transferred to the recovery room in stable condition. There were no complications.
Orthopedic Operative Samples #2
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Bilateral carpal tunnel syndrome.
POSTOPERATIVE DIAGNOSIS: Bilateral carpal tunnel syndrome.
PROCEDURES PERFORMED:
1. Left carpal tunnel release.
2. Right carpal tunnel release.
SURGEON: John Doe, MD
ANESTHESIA: MAC with local injection.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old man complaining of bilateral hand numbness and tingling. He underwent EMG testing, which showed evidence of severe carpal tunnel syndrome with evidence of denervation bilaterally. Having failed conservative management, he elected to proceed with the surgical option of bilateral carpal tunnel release.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed under monitored anesthesia care. We started on the left side. Both left and right arms were prepped and draped in the usual sterile fashion. On both sides, incisions were made with a 15 blade knife, starting from the wrist crease and extending into the palm for a distance of approximately 1-1/2 inches. We then sharply incised the superficial ligament, exposing the underlying transverse carpal ligament. The transverse carpal ligament was then incised with a 15 blade knife, exposing the underlying median nerve. The proximal and distal portions of the ligament were cut with sutures, confirming adequate release both proximally and distally. The wound was then irrigated with antibiotic solution. We closed the incisions with 3-0 interrupted nylon sutures. Sterile dry gauze dressing was placed. The identical procedure, step for step, was done on the right side. The patient tolerated the procedure well. There were no complications. The patient awoke from the monitored anesthesia care and was transferred to the recovery room and discharged home.
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right wrist median nerve compression.
POSTOPERATIVE DIAGNOSIS: Right wrist median nerve compression.
PROCEDURE PERFORMED: Right carpal tunnel release.
SURGEON: John Doe, MD
ANESTHESIA: Local, 10 mL of a 1:1 mix 0.5% Marcaine plain and 1% lidocaine with epinephrine.
COMPLICATIONS: None immediate.
ESTIMATED BLOOD LOSS: Minimal.
TOTAL TOURNIQUET TIME: Seven minutes.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old Hispanic female who complains of numbness and tingling in her right fingers, in the median nerve distribution. She has some loss of two-point sensation noted. She states that she has received no benefit from using splints full-time and nonsteroidal anti-inflammatory drug therapy. She complains also of intermittent weakness and dropping items and being awakened at night with pain and tingling in her hand. The patient was explained the risks and benefits of the procedure, which include potential increase in pain, no improvement in pain, potential scarring, and persistent pain in and around the scar and nerve injury. The patient signed written consent stating she understood these risks.
DESCRIPTION OF PROCEDURE: After explaining the potential risks and benefits of the procedure to the patient, written consent was obtained. The patient was taken to the operating room by gurney and transferred to the operating room table in the supine position. Ten mL of the above-listed local anesthetic was infused into the palm and proximal wrist of the patient’s right hand. The patient was then prepped and draped in the standard sterile fashion, and a sterile tourniquet was placed on her right forearm. A timeout was performed, indicating the patient, procedure, and site to be operated on.
The hand was wrapped for exsanguination. Tourniquet was raised to 250 mmHg. The hand was placed palm up on the table, and a 3 cm incision was made in the longitudinal fascia along the ulnar aspect of the middle finger. The incision was extended from the distal limit of the thenar eminence to the proximal wrist crease. Dissection was carried out sharply down to the level of the palmar fascia. This was incised, and we continued on down to the transverse carpal ligament. The transverse carpal ligament was observed and carefully incised. The median nerve was visible in the tunnel and protected. The release of the transverse ligament was carried out proximally and distally under direct vision.
Once we had adequate release, the patient was asked to move her fingers. There was no problem. The tourniquet was lowered, and the fingers all immediately pinked up. Hemostasis was achieved with electrocautery. The wound was then closed with 5-0 nylon horizontal mattress sutures. Bacitracin and Adaptic were placed over the incision as well as sterile gauze and Coban wrap. The patient tolerated the procedure well without any immediate complications.
