An incision in the axis of the ring finger is thought to be the safest
for carpal tunnel release based on cadaveric studies that suggest tha
t the palmar cutaneous nerves do not cross into this area. Despite the
use of this incision, persistent postoperative scar tenderness has be
en reported in up to 36% of patients following standard carpal tunnel
release. For this reason, an investigation was undertaken to determine
the presence of palmar cutaneous nerves in this incision. Random biop
sies of transversely oriented fibrous bands in the subcutaneous tissue
were taken during 15 open carpal tunnel releases. In every patient, a
t least one biopsy was positive for peripheral nerve tissue. These fin
dings, combined with previous cadaveric studies, suggest that a ''safe
'' palmar incision that will avoid injury to palmar cutaneous nerves d
oes not exist. Carpal tunnel release techniques that avoid a palmar in
cision may lessen postoperative morbidity by avoiding injury to these
small cutaneous nerves.