A 35-year-old woman presented with worsening numbness and paresthesias in the distribution of the distal median nerve. Ten cc's of local was infiltrated proximal to the distal wrist crease, deep around the median nerve, and distal to the crease in the subcutaneous palmar skin in preparation for open carpal tunnel release. Landmarks were marked for the incision.
The line (Kaplan's cardinal line) between the first web space and the hook of the hamate (see hand anatomy) was marked. The superficial palmar arterial arch lies just distal to this line. Another indicator of the location of the arch is the point at which the flexed ring finger touches the palm. The radial side of the ring finger metacarpal is used as the axis for the incision. The incision is made between Kaplan's line and the distal carpal crease, and on the ulnar side of the thenar crease to avoid injuring the palmar cutaneous branch of the median nerve.
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