Definition of a Safe-zone in Open Carpal Tunnel Surgery: a Cadaver Study

Overview

Journal Surg Radiol Anat

Specialties Anatomy & Histology
General Surgery
Radiology

Date 2009 Apr 2

PMID 19337677

Citations 7

Authors

Haluk Ozcanli

Nigar Keles Coskun

Menekse Cengiz

Nurettin Oguz

Muzaffer Sindel

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

The Reliability of Kaplan's Cardinal Line as a Potential Surface Marker for the Superficial Palmar Arch During Carpal Tunnel Release: An Anatomical Study With Surgical Perspective.

Kaur H, Patra A, Singh M, Kalyan G, Asghar A Cureus. 2023; 15(2):e35144.

PMID: 36949995 PMC: 10027112. DOI: 10.7759/cureus.35144.

Density mapping of nerve endings in the skin of the palm and flexor retinaculum of the hand. Application to open carpal tunnel release.

Hernandez-Cortes P, Hurtado-Olmo P, Roda-Murillo O, Martin-Morales N, OValle F J Anat. 2022; 242(3):362-372.

PMID: 36374977 PMC: 9919465. DOI: 10.1111/joa.13793.

A mini-incision carpal tunnel release technique to prevent pillar pain: A technical note.

Moran-Moran J, Merida-Velasco J, Del Valle E, Murillo-Gonzalez J Acta Orthop Traumatol Turc. 2021; 55(1):73-75.

PMID: 33650516 PMC: 7932731. DOI: 10.5152/j.aott.2021.20086.

Comparison of two approaches for carpal tunnel release: Extended versus mini-open technique.

Akkurt M, Duzgun S, Ates A, Yaradilmis Y Jt Dis Relat Surg. 2020; 31(1):50-5.

PMID: 32160494 PMC: 7489116. DOI: 10.5606/ehc.2020.71250.

The Prevalence of Anatomical Variations of the Median Nerve in the Carpal Tunnel: A Systematic Review and Meta-Analysis.

Henry B, Zwinczewska H, Roy J, Vikse J, Ramakrishnan P, Walocha J PLoS One. 2015; 10(8):e0136477.

PMID: 26305098 PMC: 4549253. DOI: 10.1371/journal.pone.0136477.

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