Jamie Dezenzo
True Blue
1. Right carpal tunnel syndrome.
2. Anomalous right intracarpal tunnel musculotendinous structure-palmaris tertius.
PROCEDURES PERFORMED:
1. Right carpal tunnel release.
2. Anomalous right palmaris tertius musculotendinous tendon excision/resection.
A 15 blade for curvilinear incision palm ulnar to mid thenar crease in the axis ring finger, not violating the volar wrist crease itself, through skin and subcutaneous tissue and palmar fascia. Blunt Senn retractors inserted. Loupe magnification utilized. Beaver blade for longitudinal division of transverse carpal ligament, radial to hook of the hamate, distal to the level of the superficial palmar arch. Proximal release performed, ulnar to midline, utilizing carpal tunnel retractor and Metzenbaum scissors. Freer elevator utilized to confirm adequate decompression. It became apparent upon inspection of the carpal tunnel that there was an anomalous musculotendinous structure within the carpal tunnel directly superficial to the median nerve, radial, beneath the radial leaflet of released transverse carpal ligament consistent with a palmaris tertius musculotendinous anomalous additional structure, which in light of patient's young age, it presence was felt to be a contributory potential facture towards presentation of median nerve entrapment secondary to mass effect. Therefore, an extension performed distal and proximal apex at volar wrist crease, extending distal to volar forearm. Hook retractors inserted. The anomalous palmaris tertius was resected from its distal palmaris brevis and palmar fascia insertion and approximately 5 cm proximal volar wrist crease at its muscle belly aspect. The motor recurrent branch of the median nerve was visualized and protected as well as palmar cutaneous nerve branch, which was running through the anomalous muscle belly of palmaris tertius.
Included into 64721 or bill 64721 and 25109??? Thoughts!
Thanks
Jamie
2. Anomalous right intracarpal tunnel musculotendinous structure-palmaris tertius.
PROCEDURES PERFORMED:
1. Right carpal tunnel release.
2. Anomalous right palmaris tertius musculotendinous tendon excision/resection.
A 15 blade for curvilinear incision palm ulnar to mid thenar crease in the axis ring finger, not violating the volar wrist crease itself, through skin and subcutaneous tissue and palmar fascia. Blunt Senn retractors inserted. Loupe magnification utilized. Beaver blade for longitudinal division of transverse carpal ligament, radial to hook of the hamate, distal to the level of the superficial palmar arch. Proximal release performed, ulnar to midline, utilizing carpal tunnel retractor and Metzenbaum scissors. Freer elevator utilized to confirm adequate decompression. It became apparent upon inspection of the carpal tunnel that there was an anomalous musculotendinous structure within the carpal tunnel directly superficial to the median nerve, radial, beneath the radial leaflet of released transverse carpal ligament consistent with a palmaris tertius musculotendinous anomalous additional structure, which in light of patient's young age, it presence was felt to be a contributory potential facture towards presentation of median nerve entrapment secondary to mass effect. Therefore, an extension performed distal and proximal apex at volar wrist crease, extending distal to volar forearm. Hook retractors inserted. The anomalous palmaris tertius was resected from its distal palmaris brevis and palmar fascia insertion and approximately 5 cm proximal volar wrist crease at its muscle belly aspect. The motor recurrent branch of the median nerve was visualized and protected as well as palmar cutaneous nerve branch, which was running through the anomalous muscle belly of palmaris tertius.
Included into 64721 or bill 64721 and 25109??? Thoughts!
Thanks
Jamie