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surgery carpal tunnel

What happens during the surgery?

split of carpal tunnel ligament
split of the roof of carpal tunnel

Basically, the nerve canal is expanded. Therefore, the roof of the carpal tunnel is split.

In special cases it might be necessary to split the thickened nerve wall and to remove altered tendon sheaths of the flexor tendon.

How is this done?

This can happen by a cut between the thumb ball and the small finger ball (open technique) or through splitting the roof with the help of an endoscope (endoscopical technique).

What is the difference between the open and the endoscopic splitting of the carpal roof?

The similarity of these to techniques is that the carpal tunnel is expanded after the surgery. This expanding is achieved through splitting the roof of the carpal tunnel.

Roof of carpal tunnel
Roof of carpal tunnel

The illustration shows the open splitting of the carpal tunnel.

Imagine the carpal tunnel (also called carpal cannal) like a tunnel, which leads from the forearm into the hand. This tunnel contains nine flexor tendons and the median nerve.

The bone builds the floor and both lateral edges of the carpal canal. The roof of the carpal canal is a tight ligament. This Ligament is called the roof of the carpal canal or retinakulum flexorum.

Both operational methods have in common, that the roof of the carpal tunnel is split.

How is this done with the open carpal tunnel syndrome surgery?

skin incision
Skin incision for open decompression of carpal tunnel

The skin incision is done exactly over the carpal tunnel. After incision of the skin, the fat tissue is also incised.

The illustrations shows an open splitting of the carpal roof at an early stage of the surgery. The upper layer of fat is visible. (Yellow tissue)

The illustration shows the exposed roof of the carpal tunnel. The centre hand nerve (median nerv) is expected below the red arrows.

Then, the carpal roof is split under visual control and the carpal tunnel is opened. The illustration shows this process. He nervus medianus is already visible in the section of the carpal tunnel which closer to the body.

The carpal tunnel in inspected after full splitting of the carpal roof.

Very rarely tumours or exceptional structures like an atypical tendon or heavy proliferation of the tendon sheath are found during this process.

The surgical wound is then closed with sutures. In case of servere bleeding, a small drain is applied, which will be removed after one or two days.