The patient is supine with the upper limb on an arm table and an upper arm pneumatic tourniquet in place. The wrist is flexed and a dorsal longitudinal incision is centred on the tubercle of Lister (Photo 1).

Skin is dissected medially and laterally to expose the extensor retinaculum. The articular branches of the radial nerve are divided, thus performing a partial denervation of the carpus (Photo 2).

A ‘free’ flap is harvested from the proximal extensor retinaculum transversely along its entire breadth across the wrist – 3 cm  ×  0.5 cm. This will function as a ligament to strengthen the posterior portion of the scapholunate interval (Photo 3, Fig. 3).

This extensor retinaculum is divided between the third and fourth compartments; the intercompartmental septum between the first and second compartments is released. The EPL, ECRL and ECRB tendons are retracted radially and the EDC medially.

The posterior interosseous neurovascular bundle is identified subperiosteally, medial to Lister’s tubercle. Resection of the nerve at this point completes the carpal denervation. Lister’s tubercle is minimized using a rongeur (Photo 4, Fig. 4).

The posterior capsule and posterior scapholunate ligament are exposed. A posterior capsulotomy in extended Z shape is performed as described by G. Herzberg (Photo 5, Fig. 5).