Revision Carpal Tunnel Release

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Revision Carpal Tunnel Release in a Case of Proximal Median Nerve Hematoma Injury and Mild Compression Extended Version Complications following carpal tunnel release are uncommon with patients experiencing persistent, recurrent, or new symptoms in the post-operative period. There are multiple etiolo
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Revision Carpal Tunnel Release in a Case of Proximal Nerve Injury and Mild Compression – Extended

Publicado el 11/10/2013

Revision Carpal Tunnel Release in a Case of Proximal Median Nerve Hematoma Injury and Mild Compression
Extended Version (7.120301.120229)

Complications following carpal tunnel release are uncommon with patients experiencing persistent, recurrent, or new symptoms in the post-operative period. There are multiple etiologies for recurrent carpal tunnel syndrome, which can include traction neuropathy. This is when the epineurium of the median nerve adheres to the surrounding scar tissue and prevents normal nerve gliding leading to traction neuritis. This patient lost median nerve function due to a hematoma compression that developed from a peripherally inserted central catheter in the arm. While this patient did not have sensory function, he was recovering pronator teres and flexor carpi radialis function. For any possibility of sensory recovery, a revision carpal tunnel release was performed to ensure a complete release and mild compression of the median nerve was observed. The median motor function was augmented with a reverse end-to-side nerve transfer. This case is also a demonstration of bifid median nerve in the hand.

Table of Contents
00:30 Orientation
00:41 Incision
00:54 Superficial Exposure
01:24 Identifying the Flexor Retinaculum
01:50 Identifying the Tendinous Leading-edge of the Hypothenar Muscles
02:11 Releasing the Flexor Retinaculum
03:40 Identifying the Carpal Tunnel
04:27 Releasing the Tendinous Leading-edge of the Hypothenar Muscles
05:52 Identifying the Median Nerve Proximally
07:11 Completing the Release of the Flexor Retinaculum
07:26 Releasing the Median Nerve from Surrounding Scar Tissue
08:22 Identifying the Bifurcation of the Median Nerve
09:58 Longitudinal Neurolysis of the Median Nerve
11:28 Transverse Neurolysis of the Median Nerve
12:40 Application of an Adhesion Barrier on the Median Nerve

Narration: Susan E. Mackinnon
Videography: Andrew Yee

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