CARPAL TUNNEL RELEASE - PHOTOS & INFO
Below you will be provided with photographs and information from surgeries of numerous patients with CARPAL TUNNEL SYNDROME.

SURGERY OF PATIENT I:
 
                PHOTOGRAPH #1

       
                PHOTOGRAPH #2

     
                PHOTOGRAPH #3 

This patient underwent left carpal tunnel release after having failed conservative management. During the operation, however, I discovered that his carpal tunnel was complicated by an aberrant muscle present in the carpal canal. In PHOTOGRAPH #1, the reader will see the aberrant muscle pointed out by the foam triangle in the middle. The reader will also see the median nerve lying adjacent to the foam triangle on the left and the ulnar nerve and artery are identified by the foam triangle on the right.

In PHOTOGRAPH #2, one can see the ligament and the aberrant muscle which have been cut so as to decompress the median nerve. Between the foam pointers on the left and right sides, one can see the decompressed nerve through its course in the carpal tunnel. The ligament has been retracted at the top of the screen so as to express our exposure for the photograph.

Lastly, one can see redness in the median nerve located 2/3 of the way to the right between the foam pointers indicating the area of greatest compression at the time of release.

The patient went on to do very well and at the time of last examination was symptom free.


SURGERY OF PATIENT II:
 

This is a patient who, several years prior to seeing me, underwent a carpal tunnel release accomplished by a surgeon using an endoscope.  He continued to have symptoms of carpal tunnel syndrome in his hand and after these did not go away, he came to see me. After talking with him and examining him, I felt that he had a recurrent carpal tunnel syndrome. We took him to the operating room and found a largely intact transverse carpal ligament, as indicated by the foam pointers and the inserted metal instrument. Please understand the median nerve is below the metal instrument tenting up the transverse carpal ligament. If you look at the detail between the pointers, one can see that these are uninterrupted fibers indicating that this is not just an unusual happenstance where the edges of the transverse carpal ligament hand field was scarred, but rather, these are untouched fibers.

I believe this is important for people to see, because through limited exposures, the surgeon is not always certain that the entirety of the ligament has been transected, thereby leaving patients with the possibility of an incomplete release.

This patient went on to do very well and no evidence of recurrence to date has been noted.


SURGERY OF PATIENT III:


This is a gentleman in his 80’s who presented to my office after having symptoms of carpal tunnel syndrome for many, many years. He did not seek treatment because of his stoic nature, and when I saw him he had loss of thenar muscles as demonstrated in the photo. The casual observer may not recognize what is going on here, but if the reader looks at this carefully, you can see a distinct hollow in the muscles of the thumb that allow the thumb to be pulled across the palm. This is known as thenar wasting. It occurs in advanced carpal tunnel syndrome.

For this reason, we did not waste time or money with conservative measures and went to the operating room.


​​SURGERY OF PATIENT IV:


This photo reveals a very unusual finding. The transverse carpal ligament has been cut to expose the underlying median nerve which had been compressed for so many years. The reader will see a very white or blanched appearance in the mid portion of the median nerve, and then to the right, one can see sprouts of nerve trying to bypass that intense area of pressure which has led to nerve fibrosis or substantial scarring inside the nerve. Just to the left of the blanched area, the reader can see intense redness with new vessels growing into that area in an effort for the body to try to supply that area of the nerve with oxygen, albeit an unsuccessful attempt. After careful internal neurolysis was performed, and postoperatively while we freed him from the painful symptoms that he was experiencing so that he could sleep better at night, the thumb muscles did not return.


SURGERY OF PATIENT V:


This patient was taken to the operating room, where a carpal tunnel release was performed for failure of conservative measures. Interestingly, we found that the motor branch of the median nerve had arisen from a rather unusual location on the median nerve. It arose on the little finger side of the median nerve and then traveled toward the thumb side to enervate those muscles. The reader can see this by the dotted line placed on the motor branch.

 

The reason this photo is shown is that if one is using either a limited incision without an endoscope or even with an endoscope, many times, this branch would not be seen, the carpal tunnel would be released and that branch would be cut, thereby paralyzing the thumb. This is one of the many reasons I do not do endoscopic carpal tunnel release.



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