Specific aims & objectives: Carpal tunnel syndrome (CTS) is one of the most common operative procedures performed on the hand. However, a small percentage of patients still continue to have symptoms due to either recurrence or persistence. This review aims to highlight typical presentations and suggested treatment algorithms for such patients. It is important for hand surgeons to recognise the unsuccessful initial treatment and to diagnose and treat the ongoing problem.
Methods: Herein we present a case of recurrent CTS in a 58 year old man. We perform a literature review on incidence, classification, diagnosis and treatment of this condition. An algorithm is suggested for treating such patients after defining the likely cause of the ongoing symptoms, and various treatment options described.
Results: Recurrent CTS affects anywhere between 1-31% of patients who have previously undergone carpal tunnel decompression for CTS. Rates of revisional surgery are approximately 5%. Secondary CTS is a more appropriate term to describe this condition, as it may be classified into recurrent, persistent or new CTS. Depending on the diagnosis, treatment options differ and include re-exploration, vascularised soft tissue coverage (hypothenar fat pad, pedicled muscle, adipofascial and synovial flaps) and synthetic nerve wraps. Different symptoms after an initial operation for CTS are suggestive of new CTS and iatrogenic injury should always be excluded. A brief study of electrodiagnostic modalities is also included and its relevance to this condition.
Conclusion: Symptoms of CTS after the initial operation poses a difficult problem to the patient who may have expected a usually reliable result. Postoperative symptoms should be compared to preoperative complaints and a diagnosis made. The treatment options will differ depending on the cause, but will usually have the common feature of re-exploration of the median nerve and its surroundings.