Nerve decompression for carpal and ulnar tunnel syndrome

The ulnar tube syndrome refers to the symptoms and signs of sensation and motor dysfunction caused by the compression of the ulnar nerve in the ulnar fiber line of the wrist. The ulnar tube, also known as the Guyon tube, is located on the ulnar side of the wrist area and is composed of the transverse ligament of the wrist and the distal part of the volar ligament. The ulnar artery, the ulnar vein and the ulnar nerve pass through the tube. In the tube, the ulnar nerve is divided into a deep branch and a shallow branch, that is, a sports branch and a sensory branch. The upper end of the ulnar tube is surrounded by the proximal edge of the pea bone, the volar ligament of the wrist and the transverse ligament of the wrist; the lower ligament of the ulnar tube is composed of the volar ligament of the wrist, the short palm muscle and the aponeurosis, the ligament of the bean, and the ulnar flexor tendon. And the tendon of the medial muscle of the hand is surrounded. Treatment of diseases: carpal tunnel syndrome carpal tunnel syndrome Indication Suffering from the wrist feels diminished. Contraindications Severe compression, post-traumatic neuritis, space-occupying lesions, habitual spondylolisthesis. Preoperative preparation One week before the operation, the patients were fed nutritious and digestible foods. Those with weak constitution can supplement the appropriate amount of protein and vitamins by oral or intravenous infusion. 3 days before surgery, routine orthopedic preparation, that is, on the first and second days, first wash the area with soapy water, disinfect the skin with iodine, ethanol and then use a sterile towel; on the third day, shave the hair, brush, disinfect and use Wrap the sterile towel. Carefully check the determined preparations before the operation. A sedative can be given that night to ensure a good sleep. If the body temperature rises, or women's menstrual cramps, etc., the date of surgery is delayed. Before entering the operating room, the patient empties the urine; the catheter is placed in accordance with the length of the operation, so that the bladder is in an empty state. Surgical procedure Incision design. Cut the skin, reveal and remove the transverse ligament of the scapula, see the median nerve under the ligament is compressed and thinned, and the proximal end is mildly edematous. The skin of the ulnar side of the wound was further peeled off to reveal the ulnar nerve, and the ulnar nerve was pressed under the ligament of the bean hook. Remove the ligaments, loosen the nerves, and see that the nerves are slightly thicker. Close the wound. complication Any cause of squeezing or reducing the volume of the carpal tunnel can compress the median nerve and cause carpal tunnel syndrome, Coles fracture malunion, anterior lumbar dislocation, soft tissue edema caused by infection or trauma, thickened transverse ligament of the wrist, ganglion cyst, fat Tumor, xanthomas, some systemic diseases such as obesity, diabetes, thyroid dysfunction, amyloidosis or Reynaud disease can sometimes be combined with carpal tunnel syndrome, in the early stage of the lesion, the edema and congestion of the median nerve, gradually due to oppression Ischemia causes fibrosis in the nerve, compression of the axons and disappearance of the myelin sheath. Finally, the nerve tissue is transformed into fibrous tissue, and the inner nerve tube disappears and is replaced by collagen tissue, which becomes an irreversible change.

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