Management of Recalcitrant Carpal Tunnel Syndrome

Recalcitrant carpal tunnel syndrome presents a clinical challenge. Potential etiologies of persistent or recurrent symptoms after primary carpal tunnel release include incomplete nerve decompression, secondary sites of nerve compression, unrecognized anatomic variations, irreversible nerve pathology...

Full description

Saved in:
Bibliographic Details
Published inJournal of the American Academy of Orthopaedic Surgeons Vol. 27; no. 15; p. 551
Main Authors Lauder, Alexander, Mithani, Suhail, Leversedge, Fraser J
Format Journal Article
LanguageEnglish
Published United States 01.08.2019
Subjects
Carpal Tunnel Syndrome - surgery
Humans
Neurosurgical Procedures
Recurrence
Reoperation
Treatment Failure
Online AccessGet more information

Cover

More Information
Summary:Recalcitrant carpal tunnel syndrome presents a clinical challenge. Potential etiologies of persistent or recurrent symptoms after primary carpal tunnel release include incomplete nerve decompression, secondary sites of nerve compression, unrecognized anatomic variations, irreversible nerve pathology associated with chronic compression neuropathy, perineural adhesions, conditions associated with secondary nerve compression, iatrogenic nerve injury, or inaccurate preoperative diagnosis. Understanding the pertinent surgical anatomy and pathophysiology is essential toward developing an effective diagnostic and treatment strategy. A thorough clinical history and examination guide a comprehensive diagnostic evaluation that includes serial examinations, neurophysiologic testing, and imaging studies. Conservative treatment may provide symptomatic relief; however, surgical management involving revision neuroplasty, neurolysis, nerve reconstruction, and/or local soft-tissue flap augmentation may be indicated in refractory cases.
ISSN:1940-5480
DOI:10.5435/JAAOS-D-18-00004