OrthoNet

Wrist - volar approach

* position - supine with tourniquet

* incision
- on ulnar side of thenar crease about 1/3 into hand
- curve prox. but stay out of thenar crease
- curve toward ulnar side of hand at flexion crease
- stay ulnar side of PL to preserve palmar cut. branch of median n.

* no internervous plane

* dissection
- incise skin flaps
- watch for palmar cut. branch of median n. - usu on ulnar side of FCR
- incise superficial palmar fascia in line with incision
- expose insertion of PL into flexor retinaculum
- retract PL ulnarly
- identify median n. btw tendons of PL & FCR
- incise retinaculum on ulnar side of median n. to protect motor branch
- motor branch of median n. - arises from anterolat. side of median n. as it emerges from carpal tunnel
- retract median n. radially
- retract tendons
- incise base of tunnel to expose carpus

* dangers
- palmar cut. branch of median n.
> arises 5cm prox. to wrist joint
> runs along ulnar side of FCR b4 crossing flexor retinaculum

- motor branch of median n.
> variable anatomy
> incise CT on ulnar side of median n.

- superficial palmar arch
> crosses palm at level of distal end of outstretched thumb
> blind slitting of flexor retinaculum may damage this arcade if split too far distally