Operative Technique

KnifeLightCarpal Tunnel Ligament Release

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Contents

Page

1. Features & Benefits 3

Intended Use and Indications 3

Contraindications 3

Features & Benefits 3

2. Operative Technique 4

Antegrade Approach 4

Retrograde Approach 6

Ordering Information 8

Additional Products 9

This publication sets forth detailedrecommended procedures for usingStryker Osteosynthesis devices andinstruments.

It offers guidance that you shouldheed, but, as with any such technicalguide, each surgeon must consider theparticular needs of each patient andmake appropriate adjustments whenand as required.

A workshop training is required priorto first surgery.

See package insert for a complete list ofpotential adverse effects,contraindications, warnings andprecautions. The surgeon must discussall relevant risks, including the finitelifetime of the device, with the patient,when necessary.

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Features & Benefits

Intended Use and IndicationsThe Stryker Knifelight is a manual surgical instrument used for the release of thecarpal tunnel ligament. It features an integrated light source to illuminate thesurgical site which allows for a minimally open technique with minimaldisturbance of surrounding tissue.

Features & BenefitsThe Stryker KnifeLight is a manual surgical instrument used for the release of theCarpal tunnel ligament. It features an integrated light source to illuminate thesurgical site which allows for a minimally open technique with minimaldisturbance of surrounding tissue.

• Minimally open, non-endoscopic, approach to Carpal Tunnel Ligament Release

• 1 - 2cm incision

• Illuminates ligament and surrounding landmarks

• Cutting blade is isolated from the surrounding anatomy to help avoid unintentional damage

• Smooth tip protects nerves

• Can be performed in the O.R., surgery center, or office under local anaesthesia

• Suitable for most CTLR procedural techniques

• No capital equipment required

• Packaged sterile as a single use instrument

• Up to 5 minutes uninterrupted illumination

Contraindications• Tissue adhesion in the carpal tunnel area which may potentially compromisethe safe and precise separation of the carpal ligament

• Past infection in the area of the carpal tunnel

• Previous surgical procedure in the area of the carpal tunnel, particularly a previously split carpal ligament with persistent symptoms

• Previous fracture in the area of the carpus or the distal forearm

• Skeletal deformity of the hand caused by rheumatoid arthritis

• Distinct median nerve dysfunction which requires microsurgical epineurolysis

• Nerve damage which is not caused by a compression syndrome in the area of the carpal tunnel

Moreover, the product is subject to the following general contraindicationsand limitations:

• Acute or suspected infection of the hand

• Compromized vascular flow (e.g. Raynaud's syndrome)

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Operative Technique

Minimal invasive carpal tunnel release of carpal channel

Step 1 – Landmarks and Incision

The procedure is performed with thepatient supine and the operative handsupported on a hand table. It is usuallyperformed under local anesthesia,however, surgeon preference dictatesthe type of anesthetic used. The handis prepped and draped sterilely. Aforearm or upper arm tourniquet isused to control bleeding.

Place the hand in extension on adorsal wrist support and identify theproximal part of the transverse carpalligament.

A transverse skin incision of 1-2 cm ismade at the proximal palmar wristcrease.

Step 2 – Dissection

Dissect the antebrachial fascia justulnar to the Palmaris longus tendonand expose the Median nerveproximally to it’s admittance to theCarpal Tunnel. A scissors-dissectorwith a blunt-atraumatic tip is insertedspecifically to the carpal ligament todissect aponeurotic tissues.

Antegrade Approach

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Step 3 – KnifeLight Insertion

Illuminate the KnifeLight and the area,keep the transverse carpal ligamentbetween the two short and longerprotective protruding edges of the tipwith the longer skid deep into theligament aiming distally toward thethird interdigital crease.

Step 4 – Release of CarpalLigament

Gently push the KnifeLight forward ina continuous way aiming distallytoward the third interdigital creaseuntil the ligament is completelydivided. A spot light will becomevisible under the skin in the palmarregion. A probe or a blunt dissector isinserted into the carpal tunnel to makesure the carpal tunnel is completelydecompressed.

Operative Technique

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Operative Technique

Minimal invasive carpal tunnel release of carpal channel

Step 1 – Landmarks and Incision

The procedure is performed with thepatient supine and the operative handsupported on a hand table. It isusually performed under localanesthesia, however, surgeonpreference dictates the type ofanesthetic used. The hand is preppedand draped sterilely. A forearm orupper arm tourniquet is used tocontrol bleeding. An incision is madeat the junction of Kaplan’s line and theradial border of the ring finger. Thisplaces the incision of the distal end ofthe transverse carpal ligament (TCL).

Step 2 – Dissection

Deeper dissection is facilitated usingsmall hand-held or self retainingretractors. Proximally placed Ragnellretractors retract subcutaneous fattytissue. Under direct visualization, thedistal end of the TCL is dividedexposing the contents of the carpalcanal.

Retrograde Approach

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Step 3 – KnifeLight Insertion

A hemostat is used to bluntly clean thecontents of the canal from theundersurface of the ligament. TheKnifeLight is then introduced with theupper and lower portions straddlingthe partially divided TCL.

Step 4 – Release of CarpalLigament

The KnifeLight is advanced proximallyenabling the KnifeLight blade toengage the TCL. Gentle continualforward pressure is applied as theblade transects the ligament. Thereshould be minimal resistanceencountered. Forceful advancement ofthe KnifeLight is not recommended.At no time should the KnifeLight beretracted distally and re-advanced asthis greatly increases the chance ofaccidentally transecting vitalstructures.

Operative Technique

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Ordering Information

REF Description

KnifeLight

3300-001-000 KnifeLight - Packaged Individually 10 packages/box•

h

w

• Tip Dimensions

Height: 6.3mm

Width: 4.1mm

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Additional Products

Description

VariAx - Distal Radius System

VariAx - Distal Radius System

Asnis 4.0mm Cannulated Screws

Asnis 4.0 Cannulated Screws

TwinFix Screw

TwinFix Screw

Stryker Hand Plating System

VariAx Hand plating System

Profyle Modular System for small fragments

CORE Micro System

CORE Micro System

Dual-Cut Saw Blades

Dual-Cut Saw Blades

Hand Extension Device

Hand Extension Device

Hoffmann II Micro-Fixator

Hoffmann II Micro-Fixator

Asnis Micro 2.0mm, 3.0mm cannulated screws

Asnis Micro 2.0mm, 3.0mm cannulated screws

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Notes

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Notes

Stryker Leibinger GmbH & Co. KGBötzinger Strasse 41D-79111 Freiburg Germany

www.osteosynthesis.stryker.com

This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or herown professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. The information presented in this brochure is intended to demonstrate aStryker product. Always refer to the package insert, product label and/or user instructions including the instructionsfor Cleaning and Sterilization (if applicable) before using any Stryker products. Products may not be available in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets. Pleasecontact your Stryker representative if you have questions about the availability of Stryker products in your area.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the followingtrademarks or service marks: Stryker, Asnis, VariAx, Twin Fix, Profyle, Core, Hoffmann II, KnifeLight.

All other trademarks are trademarks of their respective owners or holders. The products listed above are CE marked.

Literature Number: 982355 LOT A4409

Copyright © 2010 Stryker