Post op diagnosis: Right carpal tunnel syndrome
Right volar wrist mass
Operations Performed: Right Carpal decompression
Excision of right volar wrist mass
Flexor Tenosynovectomy
Neurolysis, external of the median nerve
Description of procedure:
A 15-blade was used to make an axial incision directly ove the carpal tunnel in the mid palm directly between the hypothenar and thenar eminences. The incision was approximately 1.5 cm long. This was carried down to subcutaneous tissue. retractor was placed within the confines of the would to afford exposure. dissection continued down until the palmaris longus was encountered. This was incised longitudinally and the palmaris brevis musculature was spread until the transverse carpal ligament was exposed. This was incised for a short distance. Care was taken to preserve the median nerve underneath.
Next the sled for the carpal tunnel knife was advanced proximally into the wrist underneath the transverse carpal ligament with care being taken to keep the median nerve under the sled. After this was done, the knife was advanced in the groove in the sled dividing the proximal portion of the transverse carpal ligament. Next, the knife and sled were removed and advanced distally towards the head of the fourth metacarpal underneath the transverse carpal ligament.
After sled was advanced, the knife was then advanced in the groove in the sled, dividing the transverse carpal ligament distally. The sled and knife were withdrawn. The wound was inspected and the transverse carpal ligament was noted to be divided completely along its length. The median nerve was intact.
A 15-blade was used to make a transverse incision directly over the area of the mass. The skin flap was elevated. The mass was turned out to be inflamed tenosynovium just proximal to the edge of the transverse carpal ligament. It was excised completely using tenotomy scissors. Flexor tenosynovectomy was performed and was passed off as field specimen. It should be noted that neurolysis of the median nerve was performed at the same time as this mass was somewhat adherent to the nerve.
My codes:
D48.1 – 26145-RT, 25075-51 RT, 64722-51 RT
G56.01 – 64721, 59 RT
Any help would be appreciated!!! Thank you!!!