Clinical, Electrophysiological, And Intraoperative Analysis And Post Operative Success Of Revision Surgery For Persistent And Recurrent Carpal Tunnel Syndrome
Jerrick Robker, DO1, Andrew Li, MD2, Neil Jones, MD3.
1Children's hospital of Orange County, Orange, CA, USA, 2University of California, Davis, Sacramento, CA, USA, 3University of California, Los Angeles, Los Angeles, CA, USA.
PURPOSE: To describe the most frequent preoperative findings in diagnosing recurrent or persistent carpal tunnel syndrome, and to describe frequent intra-operative findings during revision surgery that likely contribute to recurrent or persistent carpal tunnel symptoms. METHODS: A retrospective review of the surgical findings and outcomes of 29 consecutive patients who had undergone 30 revision carpal tunnel operations for persistent or recurrent carpal tunnel symptoms following index carpal tunnel release RESULTS: Thirty hands in 29 consecutive patients underwent a second operation by a single surgeon. On preoperative examination, 77% demonstrated ABP weakness, 67% demonstrated a positive Phalen sign, and 63% demonstrated ring finger “sensory splitting.” Incomplete release of the TCL and circumferential fibrosis were the most common intra-operative findings, totaling 20 cases each, intact antebrachial fascia in 8 cases, volar subluxation of the median nerve in 5 cases, compression of the median nerve by palmaris longus in 4 cases, and flexor tenosynovitis in 4 cases. Nine patients (34%) had complete resolution of symptoms after the revision carpal tunnel release. Fifteen (58%) had improvement in symptoms, and two patients did not report improvement. CONCLUSION: The most common intraoperative findings in revision carpal tunnel surgery is incomplete release of the TCL and/or antebrachial fascia, and perineurial scarring. Persistent carpal tunnel syndrome is almost always secondary to incomplete division of the TCL and/ or the antebrachial fascia. In recurrent carpal tunnel syndrome with an already released TCL, the most likely culprit is perineurial fibrosis, which may portend non-resolution of symptoms following the revision release.
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