Laceration of Median Nerve During Carpal Tunnel Syndrome Procedure

Michael Talve, CEO

Written by
— Updated on September 27, 2017

This case involves a thirty-two-year-old male who presented to his doctor with complaints of numbness in both hands, weakness of hand grip, and pinch movements. The plaintiff’s carpal tunnel injuries were claimed to have derived from a working environment with poor ergonomics. Following an EMG and nerve conduction test that demonstrated bilateral carpal tunnel syndrome, the physician recommended the need for an open surgical procedure. The patient underwent a procedure in which a microsurgical neurolysis and excision of a neuroma were conducted. The operative note also reports that grafting of the left median nerve was necessary as the neuroma invaded significantly into the nerve fibers. A second opinion was sought, and the independent surgeon stated that patient’s median nerve was lacerated, which would result in permanent injury to the patient. The patient has yet, and is not expected, to regain normal strength, sensation, or function in his left hand.

 

Question(s) For Expert Witness

  • 1. What is the standard of care in this procedure in protecting the underlying nerve and its branches?

Expert Witness Response E-005512

Open carpal tunnel release surgery is the traditional procedure used to correct carpal tunnel syndrome by the decompression of the median nerve. Decompression is achieved via an incision through the transverse carpal ligament, thereby enlarging the carpal canal and relieving the compressive force on the median nerve. A palmar longitudinal incision is curved along the axis of the ring finger, between the thenar and hypothenar eminences. The incision should extend distally enough to allow for complete division of the transverse carpal ligament, while not injuring the palmer cutaneous branch of the median nerve or the superficial palmer arterial arch. Any deviation from these stepwise methods to protect the median nerve and its branches would be considered a breach in care.

Contact this expert witness

Find a General Surgery Expert Witness Near You

What State is your case in?

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY