cclarson
Guru
Hello, one of the doctors at our facility performed a carpal tunnel release with a cubital tunnel release at the elbow and a Guyon Canyon release. I don't believe there are any bundling issues with these three procedures, but the doctor also mentioned doing a flexor tendon lengthening. Would this be bundled? Looking at the op note, I assume that it is, but I wanted a second opinion. Thank you in advance!
Here is the op note:
POSTOPERATIVE DIAGNOSES:
Right carpal tunnel syndrome and ulnar neuropathy of the wrist and the elbow.
PROCEDURE PERFORMED:
Right carpal tunnel release, Guyon canal release, cubital tunnel release with submuscular ulnar nerve transposition and flexor tendon lengthening.
Indications:
The patient presents with symptomatic carpal tunnel syndrome, as well as ulnar nerve neuropathy with atrophy. The risks benefits and alternatives have been discussed with the patient and he elects to proceed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative holding area. He was then brought to the operating room and placed supine with the right hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
An incision was made in the palm in line with the fourth ray and was carried across the wrist crease proximally in a Brunner fashion.
At this point the transverse carpal ligament was identified. This was released longitudinally and distally to the palmar fat. We then turned our attention proximally and the antebrachial fascia was released under direct visualization. We then identified the ulnar neurovascular bundle, and this was released proximally across the wrist and then distally. We then released the hypothenar muscles off of the hamate and identified the deep motor branch which was released.
We then turned our attention to the elbow and an incision was made centered over the medial epicondyle. We dissected down through the subcutaneous tissues and identified the nerve. There was a branch of the MABC that was identified and protected. We then opened the flexor pronator fascia, identified the ulnar nerve and this was released proximally. A segment of the medial intermuscular septum was released. We then elevated our fascial flaps and released the tendon from the medial epicondyle. The ulnar nerve was then mobilized and was transposed anteriorly. The fascial flaps were repaired, lengthened with 3-0 Ethibond sutures. The tourniquet was deflated. Hemostasis was obtained. The wounds were irrigated and were closed with interrupted Monocryl at the elbow and then nylon sutures at the wrist and a posterior splint was applied. The patient tolerated the procedure well without complications.
Here is the op note:
POSTOPERATIVE DIAGNOSES:
Right carpal tunnel syndrome and ulnar neuropathy of the wrist and the elbow.
PROCEDURE PERFORMED:
Right carpal tunnel release, Guyon canal release, cubital tunnel release with submuscular ulnar nerve transposition and flexor tendon lengthening.
Indications:
The patient presents with symptomatic carpal tunnel syndrome, as well as ulnar nerve neuropathy with atrophy. The risks benefits and alternatives have been discussed with the patient and he elects to proceed. Informed consent was obtained.
DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative holding area. He was then brought to the operating room and placed supine with the right hand on the hand table. Anesthesia was induced. The arm was then prepped and draped in normal sterile fashion. Timeout was performed and preoperative antibiotics were given.
An incision was made in the palm in line with the fourth ray and was carried across the wrist crease proximally in a Brunner fashion.
At this point the transverse carpal ligament was identified. This was released longitudinally and distally to the palmar fat. We then turned our attention proximally and the antebrachial fascia was released under direct visualization. We then identified the ulnar neurovascular bundle, and this was released proximally across the wrist and then distally. We then released the hypothenar muscles off of the hamate and identified the deep motor branch which was released.
We then turned our attention to the elbow and an incision was made centered over the medial epicondyle. We dissected down through the subcutaneous tissues and identified the nerve. There was a branch of the MABC that was identified and protected. We then opened the flexor pronator fascia, identified the ulnar nerve and this was released proximally. A segment of the medial intermuscular septum was released. We then elevated our fascial flaps and released the tendon from the medial epicondyle. The ulnar nerve was then mobilized and was transposed anteriorly. The fascial flaps were repaired, lengthened with 3-0 Ethibond sutures. The tourniquet was deflated. Hemostasis was obtained. The wounds were irrigated and were closed with interrupted Monocryl at the elbow and then nylon sutures at the wrist and a posterior splint was applied. The patient tolerated the procedure well without complications.