持续性症状和不完全释放的腕管松解术

                               
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Failure to resolve symptoms of carpal tunnel syndrome following a release of the flexor retinaculum can occur for a number of reasons. Failed carpal tunnel can be classified into three categories and include (1) persistent symptoms, (2) recurrent symptoms, and (3) new symptoms. Persistent symptoms of median nerve dysfunction can imply an incomplete release and/or wrong initial diagnosis with other associated problems, which can include proximal median nerve compression and/or cervical disc disease. Revision surgery is appropriate for patients with an incomplete release. In this case, the patient presented with a loss of median motor/sensory function immediately after surgery and pain in the territory of the palmar cutaneous branch of the median nerve. Provocative tests revealed findings comparable with an incomplete release of the carpal tunnel. Revision surgery was elected and an incomplete proximal release of the flexor retinaculum was found. Additionally, this patient had a palmar cutaneous branch with an aberrant course through the flexor retinaculum into the territory of the first incision. This branch was managed with a proximal transposition.

Tables of Contents (Standard)
00:30 Orientation / Incision / Exposure
00:49 Exposure of the Median Nerve Proximal to the Previous Surgery
01:13 Exposure / Release of the Proximal Flexor Retinaculum and Antebrachial Fascia
01:59 Exposure of the Distal Flexor Retinaculum
02:12 Identifying of the Palmar Cutaneous Branch of Ulnar Nerve
02:31 Identifying the "V" Intersection between the Thenar and Hypothenar Muscles
02:57 Release of the Distal Flexor Retinaculum
03:20 Separating the Median Nerve from the Overlying Attachment to the Flexor Retinaculum
03:36 Identifying an Aberrant Branch of the Palmar Cutaneous Branch of Median Nerve
04:53 Longitudinal Epineurial Neurolysis of the Median Nerve
06:39 Transverse Epineurial Neurolysis of the Median Nerve
07:09 Proximal Transposition of Cutaneous Branch with Cautery Cap and Proximal Crush
07:52 Inspection of Median Nerve Following Release
08:26 Demonstration of the Recurrent Thenar Motor Branch of Median Nerve