Surgical correction of iatrogenic lesion of the median nerve after endoscopic decompression: Case report

Abstract

Introduction: Carpal tunnel syndrome is neuropathy of compressive origin, surgical treatment can present complications that are difficult to solve, among them, painful neuromas of the peripheral nerves, affecting 2–60% of patients with nerve damage. There is no consensus on the ideal treatment for painful neuroma. Consequently, numerous modalities to treat neuroma pain are described. Case report: Female, 45 years old, presented with a left hand carpal tunnel syndrome clinic. There is a report of having undergone a surgical procedure for decompression of the carpal tunnel with endoscopy, progressing with worsening of symptoms. Another surgical procedure was performed (conventional open route) in the region of the left wrist with intra-op visualization of total nerve rupture. Neurorrhaphy of the median nerve was performed. Patient came to our service complaining of severe pain (VAS 9/10) in median nerve topography associated with paresis of the muscles innervated by the same. Neuroma resection and sural nerve grafting for the tenar motor branch, ulnar and radial median group and patient evolved with significant pain improvement (VAS of 2/10). Discussion: A wide variety of surgical techniques are described to treat painful neuroma. In this case, the success of the chosen tchnique is evidenced by the drop of 07 points in the VAS. Conclusion: It is evident that the endoscopic correction of carpal tunnel syndrome is not without complications and should be indicated with caution. It is necessary to carry out more studies that can evidence the best conduct for each case.