title: Open carpal tunnel release with use of a nasal turbinate speculum.
abstract: Incomplete release of the transverse carpal ligament (TCL) and median nerve injury are complications of carpal tunnel release (CTR). In this article, we describe a modified mini-open release using a fine nasal turbinate speculum to aid in the proximal release with direct visualization of the proximal limb of the TCL and the distal volar forearm fascia (DVFF). The technique begins with a 2.5-cm palmar longitudinal incision, and standard distal release of the TCL is completed. A fine nasal turbinate speculum is inserted into the plane above the proximal limb of the TCL and the DVFF. A long-handle scalpel is used to incise the TCL and the DVFF under direct visualization. We retrospectively analyzed a cohort of 101 consecutive CTR cases (63 right, 38 left). Carpal tunnel syndrome symptoms were relieved in all patients with a high degree of satisfaction. This modified mini-open technique provides surgeons with a reproducible and inexpensive method to ensure a safe proximal release of the TCL.
authors.forename: Raghuveer C
authors.initials: RC
authors.lastname: Muppavarapu
authors.forename: Sean S
authors.initials: SS
authors.lastname: Rajaee
authors.affiliation: Hand Surgery PC, Newton-Wellesley Hospital, Tufts University School of Medicine, Newton, MA; and Department of Orthopaedic Surgery, Masachusetts General Hospital/Harvard Medical School, Boston, MA. druchelsman@mgh.harvard.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Ruchelsman
authors.forename: Mark R
authors.initials: MR
authors.lastname: Belsky
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D014953:Wrist / Q000601:surgery; D014955:Wrist Joint / Q000601:surgery