Revision Surgery after Carpal Tunnel Release –Analysis of the Pathology in 200 Cases during a 2 Year Period

Abstract

Carpal tunnel release (CTR) is regarded as a common and successful operative procedure in hand surgery. However, an increasing number of patients with complications have been referred to our hospital. This retrospective investigation was undertaken to clarify the reasons for persisting or recurrent symptoms in 200 patients who underwent secondary exploration during a 26 month period at a single institution. In 108 cases, the flexor retinaculum was found to have been released incompletely. In 12 patients, a nerve laceration had occurred during the primary intervention. In 46 patients, symptoms were due to the nerve being tethered in scar tissue. The re-exploration revealed circumferential fibrosis around and within the median nerve in 17 patients and a tumour in the carpal tunnel in four patients. In 13 patients, no specific reason was found for recurrence of symptoms. We conclude that CTR seems to be a widely underestimated procedure and revision surgery could be largely avoided by reducing technical errors during the primary operation.

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

“…Consistent with existing literature (2, 13), nerve injury was almost exclusively seen in patients presenting with new CTS. Inadvertent transection of the superficial median fascicles, the third common digital nerve, and median nerve PCB were most common, as in the study by Stutz et al (12). While relatively uncommon, inadvertent nerve injury during CTR can be devastatingly life-altering for the patient, and the importance of excellent visualization and a cautious, methodical approach to CTR cannot be overstated.…”

“…Persistent CTS refers to the persistence of preoperative symptoms following carpal tunnel release with little or no improvement. Of the complications following CTR, persistence is the most common and is often due to incomplete release of the flexor retinaculum or to incorrect diagnosis (2,12,13). Recurrent CTS refers to when the primary release was successful in relieving symptoms, but similar symptoms recur after a period of months or years.…”

“…New symptoms are often reported as increased pain or different symptoms immediately following primary CTR. New symptoms are typically a result of nerve injury, which can include the median nerve proper, common digital nerves, palmar cutaneous branch of the median nerve, or the ulnar nerve (2,12,13).…”

Reducing Neurologic and Vascular Complications of Endoscopic Carpal Tunnel Release Using a Modified Chow Technique

“…One of the drawbacks of ECTR is the incomplete release of the TCL (17). This can be easily and effectively resolved if the endoscope is inserted into the carpal tunnel from the entry portal and the stumps of the TCL are confirmed from proximal end toward the distal end.…”

Chiropractic management of work-related upper limb disorder complicated by intraosseous ganglion cysts: a case report

“…19 Another study found that most postsurgical complications may be attributed to technical errors during the initial procedure. 20 The presence of CTS with ganglion cysts has been shown to result in deafferentation and motor deficits. Twelve cases of ganglion cysts and CTS were reported, with 8 cases demonstrating abnormal motor conduction or distal sensory latencies.…”