Evaluation and Treatment of Failed Carpal Tunnel Surgery

Abstract

C arpal tunnel syndrome is the most common nerve entrapment syndrome treated in the United States, affecting approximately 1% of the population. 1–3 Initial treatment for carpal tunnel syndrome is usually nonoperative and includes the use of splints, non-steroidal anti-inflammatory agents, and steroid injections. If these methods fail, then operative intervention is frequently indicated. Open carpal tunnel release (CTR) has been the gold standard for operative treat-ment of carpal tunnel syndrome. 4 With the recent advent of endoscopic CTR, the gold standard has been challenged. Endoscopic CTR offers the advantages of a quicker return to work and less scar tenderness to the patient. However, open CTR affords the patient a lower complication rate and better visualization of the nerve and the contents of the carpal canal. 5,6 No matter which technique is chosen the vast majority of patients obtain relief of their symptoms following CTR. Reviews of large series of patients reveal an incidence of failure or incomplete relief of symptoms that ranges from 1.6 to 25%. 4,7–9 The evaluation and treatment of this subset of patients can be difficult. The incidence of reoperation for failed carpal tunnel syndrome has been estimated as approximately 0.5%. 10 This article will help the clinician sort through the history, physical exam, and supportive studies of