Volar Approach to the Carpal Tunnel and Wrist.pptx

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1. Volar Approach to the Carpal Tunnel and Wrist Dr ALBAHANSA

2. INDICATION 1. Decompression of the median nerve 2. Synovectomy of the flexor tendons of the wrist 3. Excision of tumors within the carpal tunnel 4. Repair of lacerations of nerves or tendons within the tunnel 379 5. Drainage of sepsis tracking up from the midpalmar space 6. Open reduction and internal fixation of certain fractures and dislocations of the distal radius and carpus, including volar lip fractures of the radius and transscaphoid perilunate dislocations

3. POSITION OF THE PATIENT Place the patient supine on an operating table. Rest the forearm on a hand table in the supinated position so that the palm faces upward. Use an exsanguinating bandage

4. LANDMARKS Landmarks The thenar crease runs around the base of the thenar eminence. The proximal transverse skin crease of the wrist overlies the wrist joint. The tendon of the palmaris longus muscle bisects the anterior aspect of the wrist. Its distal end bisects the anterior surface of the carpal tunnel. It is easy to palpate in the distal forearm if the patient is instructed to pinch the fingers together and flex the wrist.

5. INCISION

6. DISSECTION

7. DISSECTION

8. DISSECTION

9. DISSECTION