Definition of a safe-zone in open carpal tunnel surgery: a cadaver study

Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpa...

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Bibliographic Details
Published in:Surgical and radiologic anatomy (English ed.) 2010-03, Vol.32 (3), p.203-206
Main Authors: Ozcanli, Haluk, Coskun, Nigar Keles, Cengiz, Menekşe, Oguz, Nurettin, Sindel, Muzaffer
Format: Article
Language:English
Subjects:
Anatomy
Anatomy & physiology
Cadaver
Carpal tunnel syndrome
Carpal Tunnel Syndrome - surgery
Hand surgery
Humans
Imaging
Median Nerve - surgery
Medicine
Medicine & Public Health
Nervous system
Original Article
Orthopedics
Postoperative Complications - prevention & control
Radiology
Surgery
Ulnar Nerve - surgery
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Summary:Carpal tunnel decompression is one of the most common surgical procedures in hand surgery. Cutaneous innervation of the palm by median and ulnar nerves was evaluated to find a suitable incision preserving cutaneous nerves. A morphometric study was designed to define the safe-zone for mini-open carpal tunnel release. Sixteen fresh-frozen (8 right, 8 left) and 14 formalin-fixed (8 right, 6 left) cadaveric hands were dissected. Anatomy of the palmar cutaneous branch of the median and the ulnar nerve, motor branch of the median nerve, superficial palmar arch were evaluated relative to the surgical incision. We also identified the motor branch of the median nerve. Detailed measurements of the whole palmar region are reported in this study. The motor branch of the median nerve was extraligamentous as 60%, subligamentous as 34%, transligamentous as 6%. The palmar cutaneous branches of the median and the ulnar nerves in the palmar region were classified as Type A (34%), Type B (13%), Type C (13%), Type D (none), Type E (40%) according to forms of palmar cutaneous innervation originating from the ulnar and median nerves. Injury to the palmar cutaneous branch of the median nerve (PCBMN) is the most common complication of the carpal tunnel surgery. Various techniques were described to decrease post-operative morbidity. Based on these anatomic findings mini incision between the superficial palmar arch and the most distal part of the PCBMN in the palmar region is the safe-zone for carpal tunnel surgery.
ISSN:0930-1038
1279-8517
DOI:10.1007/s00276-009-0498-7