Rheumatoid CTR + Release Guyon’s Canal 2013-09-12T13:27:47+00:00

Carpal Tunnel and Guyon’s Canal Release in a Rheumatoid Arthritis Patient

Carpal tunnel syndrome (CTS) is a common result of the inflammation caused by rheumatoid arthritis. CTS occurs when there is pressure on the median nerve in the carpal tunnel, which is a narrow space formed by a semi-circle of bones on the back side of the wrist and a ligament that crosses the bones on the palm side of the hand.

Tendons also run through the carpal tunnel with the median nerve. The tendons are surrounded by synovium which is a slippery tissue that secretes fluid to lubricate the tendons so they may pass each other without friction. In rheumatoid arthritis inflammation of this tissue causes swelling,  and fills all the extra room in the carpal tunnel until pressure is applied to the median nerve compromising its circulation causing carpal tunnel symptoms including numbness, tingling and pain.

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  Lateral view revealing extensive swelling of the volar forearm just proximal to the carpal tunnel.

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  The hypertrophic inflamed synovium extends into the carpal tunnel putting pressure on the median nerve.

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  Initial exposure reveals extensive synovitis and “Rice Body” formation of the wrist flexor tendon bursae.

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  Rheumatoid arthritis produces a state of chronic inflammation which is believed to play a role in rice bodies.  Rice bodies are cells of a cartilage-like material that resemble grains of rice in tendons, bursae, or synovium.

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  Compression of the ulnar nerve by a fascial band is evident in Guyon’s canal.

 

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient

Probe under the fascial band compressing the unlar nerve in Guyon’s canal is demonstrated.

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient

The flexor tendons and median nerve are dissected free of the large rice body and diseased bursae.

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient   The diseased radial and ulnar bursae have been completely excised.

 

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  The carpal tunnel and Guyon’s canal have been fully released and all diseased tissue removed, providing decompression and relief of neuropathic pain and other symptoms related to nerve compression.

 

 

 

 

 

 

Carpal Tunnel and Guyon's Canal Release in a Rheumatoid Arthritis Patient  Close up view of decompressed hand.