Minimally invasive carpal tunnel decompression using the KnifeLight: How I Do It
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HOW I DO IT - PERIPHERAL NERVES
Minimally invasive carpal tunnel decompression using the KnifeLight: How I Do It Shi Qing Lee 1
&
Peter Y. K. Hwang 1
Received: 17 October 2020 / Accepted: 12 November 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Carpal tunnel decompression is commonly performed open or endoscopically. Carpal tunnel release using the KnifeLight instrument (Stryker, Kalamazoo, MI) is an alternative method established in 2000. Method The instrument has a cutting blade placed between two blunt flat tips with an integrated light source which helps to locate the tool blade by transillumination through the tissues. The instrument is inserted into an opening made in the wrist crease and transverse carpal ligament and used to divide the ligament. Conclusion This is a simple, efficient, and reproducible alternative for carpal tunnel decompression. Keywords Carpal tunnel release . Surgical procedures . KnifeLight
Relevant surgical anatomy Carpal tunnel syndrome is a result of compression of the median nerve. Carpal tunnel is defined by scaphoid tubercle and trapezium radially, hook of hamate and pisiform ulnarly, transverse carpal ligament as the roof, and proximal carpal row as the floor (scaphoid, lunate, triquetrum, pisiform). The carpal tunnel contains nine tendons and a nerve: the flexor pollicis longus, the four flexor digitorum superficialis, the four flexor digitorum profundus and the median nerve. The median nerve emerges from the brachial plexus in the upper arm with contributions from the C6, C7, C8 and T1 nerve roots. Roots C6 and C7 supply the median sensory fibres that provide sensation to the thenar eminence and the first three and a half digits of the hand. Roots C8 and T1 supply the motor fibres to the muscles of the forearm and hand that are innervated by the median nerve. In carpal tunnel syndrome, innervation to the thenar muscles and lateral two lumbricals in the hand are This article is part of the Topical Collection on Peripheral Nerves * Shi Qing Lee [email protected] Peter Y. K. Hwang [email protected] 1
Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
affected. The palmar cutaneous branch, which innervates the lateral aspect of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand are also affected.
Description of the technique The KnifeLight instrument (Stryker, Kalamazoo, MI) has a handpiece that is connected to a blade assembly where a cutting blade is placed between two blunt flat tips. An integrated light source illuminates the surgical site which will improve visualisation. Use of the instrument was first established in 2000 [1] (Fig. 1). Following anaesthesia, position and drape the patient’s wrist and hand with the palmar surface facing up. Mark the following landmarks: 1. Transverse line at the distal wrist crease over the transverse carpal ligament 2. Sc
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