Recurrent symptoms after carpal tunnel release are a significant challenge to hand surgeons. Recurrent carpal tunnel syndrome (CTS) may occur from incomplete surgical release, recurrence of local compression, and/or neural scarring or adhesions in a suboptimal bed; all may be confounded by neuropathic or complex regional pain syndromes. Incomplete initial release and recurrence of local compression may be treated successfully with repeat decompression and is not discussed. This discussion reviews the more complicated scenario of median nerve scarring to surrounding structures. Concomitant treatment of associated neuropathic pain is not addressed directly. Conservative treatment for recurrent CTS may provide immediate, but transient, relief of symptoms, or may provide no benefit for underlying median nerve compression or irritation. Surgical management of recurrent CTS secondary to external perineural fibrosis involves neurolysis, changing the environment to minimize the effects of tenosynovitis, fibrous proliferation within the carpal tunnel, intraneural fascicular scarring, and adherence of the median nerve to the transverse carpal ligament, and early motion. This paper presents the techniques available to effectively treat recurrent CTS. Options include nerve wrapping, local autologous flaps, and pedicled flaps that provide a favorable local environment for the median nerve excursion. Key Words: Recurrent Carpal Tunnel Syndrome-Nerve wrapping-Local autologous flaps-Pedicled flaps.Carpal tunnel syndrome (CTS) is common and is treated with open or endoscopic carpal tunnel release (CTR) when nonoperative means fail. Unfortunately, persistence of symptoms or recurrence of CTS is frequent. Recurrent symptoms of CTS have been shown to occur in 0 to 20% of patients following CTR, with up to 12% requiring re-exploration. 4,6,11,12,30,35 The management of recurrent entrapment neuropathy is difficult and controversial. The results following reoperation have not been as successful as primary surgery, with up to 95% residual symptoms and 40% poor results. 42,57 Eighteen percent (18%) of workers' compensation patients improved after revision carpal tunnel surgery compared with 84% of those with conventional insurance. 24 Repeated nerve decompression, alone or accompanied with external or internal neurolysis, does not always relieve symptoms. 16 Multiple factors have been associated with poor results, including injury to the median nerve either from chronic compression or iatrogenic surgical injury, excessive scar formation preventing the nerve from gliding with wrist motion, subcutaneous atrophy of the palm, incomplete surgical release, and patient secondary gain factors. 6,12,22,25,66 In addition, neuropathic pain, manifested by excessive pain, autonomic dysfunction, trophic changes, and functional impairment may coexist.A thorough clinical evaluation, including a complete neurologic examination of the neck and the entire upper extremity, is essential to confirm the accuracy of the original diagnosis. The presence of anoth...
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