Complications of carpal tunnel surgery

Abstract

During a 12-year period, the authors treated 25 patients with 26 complications of previous carpal tunnel surgery. Twenty-four of these patients were referred following initial surgery elsewhere. The most frequent complication identified was neuroma of the palmar cutaneous branch of the median nerve in 14 of the cases. Other complications were hypertrophic scars, dysesthesias after multiple procedures to release the carpal tunnel, joint stiffness, failure to relieve symptoms, and neuromas of the dorsal sensory branch of the radial nerve. All of these complications are potentially preventable. With a properly placed incision, exposure carried out under magnification, and surgery under direct vision the majority of these complications may be prevented. It is further noted that the technique of transverse incision at the wrist for release of the carpal tunnel is potentially dangerous and should be abandoned.

Study to Assess Differences in Outcome Following Open Carpal Tunnel Decompressions Performed by Surgeons of Differing Grade

“…The overall complication rate was 33%, which is higher than in other series; 1,5 however, the pattern of complications also differs considerably as a majority of our complications were due to scar tenderness, which accounted for 42% of all the complications. Persistent symptoms, which could suggest intraneural fibrosis or incomplete division of the transverse carpal ligament, occurred in only 7% of cases, which is lower than in other series.…”

“…Complications following carpal tunnel decompression vary from scar tenderness to incomplete division of the transverse carpal ligament or even division of the median nerve and studies report complication rates up to 12-20%. 1 This frequency combined with the large number of patients who undergo carpal tunnel decompression amount to a significant total morbidity.…”

“…While surgical decompression is a popular and effective means of treatment, complications following carpal tunnel decompression have been reported in 12-20% of cases. 1 Data gathered from a joint cross-Atlantic study to assess outcome after carpal tunnel surgery was reviewed to see if grade of surgeon performing the carpal tunnel decompression had any bearing on outcome. This allowed us the opportunity to analyse data on a large number of patients who had undergone carpal tunnel decompression.…”

Estudo morfológico do ramo superficial do nervo radial

“…Em estudo experimental sobre a introdução percutânea de fios de Kirschner evidenciou-se lesão ou deslocamento do RSNR em 32% dos casos (23) . Existem muitos relatos na literatura de lesão do RSNR no nível do punho (7)(8)(9)(10)(11)(12)(13)(14)16,18,19,23) . O conhecimento das variações anatômicas deste nervo e a realização de pequenas incisões longitudinais com dissecção romba e separação lateral de partes moles até o plano ósseo, pode contribuir para a prevenção deste tipo de lesão.…”

“…Na última década poucas descrições detalhadas do RSNR e seus ramos foram publicadas (1)(2)(3)(4)(5)(6) . Porém, inúmeros casos de dor intratável causada por lesões neste nervo foram relatados (7)(8)(9)(10)(11)(12)(13)(14) .…”