Secondary Carpal Tunnel Surgery

Learning Objectives: After studying this article, the participant should be able to: 1. Describe and classify the problems commonly seen after carpal tunnel surgery and their probable causes. 2. Be familiar with the relevant anatomy of the median nerve and its branches. 3. Discuss the clinical evaluation of the patient after failed carpal tunnel release. 4. Describe the surgical techniques used in secondary carpal tunnel surgery, including neuroma management, nerve grafting, and flap coverage. A small but significant group of patients with carpal tunnel syndrome “fail” primary carpal tunnel release and require secondary surgery. The persistence or recurrence of previous symptoms or the development of new symptoms is often indicative of the nature of the patient's problem. Postoperative complications may be classified into the general areas of neurological, vascular, tendon, and wrist complaints. A thorough clinical evaluation, including a complete neurological examination of the hand and upper extremity, provides an accurate assessment of the status of the median nerve. Important surgical techniques that may be used during secondary carpal tunnel surgery include internal neurolysis, neuroma-in-continuity assessment, neuroma management, nerve grafting, and tissue interposition flaps. (Plast. Reconstr. Surg. 107: 1830, 2001.)