Arch Hand Microsurg.  2022 Jun;27(2):187-192. 10.12790/ahm.21.0147.

Standard incision and median nerve external neurolysis for recalcitrant carpal tunnel syndrome

• Al-Dhafer BA
• Kim SY
• Shin YH
• Kim JK
• Choi SW

• KMID: 2531927
• DOI: http://doi.org/10.12790/ahm.21.0147

Abstract

Purpose
Failed carpal tunnel surgery poses a challenge for the attending surgeon(s). Numerous revision techniques have been reported in the literature, with evidence of long-term improvement. However, studies exploring how early could symptomatic improvement be detected are scarce. The objective of this study was to identify the speed of symptom(s) recovery after a repeated decompression technique using an open standard incision and median external nerve neurolysis with no supplemental procedures.
Methods
Nine patients who underwent revision carpal tunnel surgery involving standard incision, external median neurolysis, and no supplemental techniques between June 2017 and June 2020, were included. Data regarding the preoperative Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score, Disabilities of the Arm, Shoulder and Hand score, visual analogue score, and grip strength were collected and compared with evaluation results at 3 months postoperatively.
Results
In all patients, severe adhesion of the median nerve with the surrounding soft tissue was confirmed intraoperatively. Compared with preoperative findings, 3-month evaluation of patients demonstrated a statistically significant improvement in the BCTQ symptoms score and pain score. All nine patients were satisfied with the procedure.
Conclusion
Standard incision and median nerve external neurolysis can be a good option for recalcitrant carpal tunnel syndrome patient who has an adhesion of the median nerve with surrounding soft tissue.

Keyword

Carpal tunnel syndrome; Recalcitrant; Revision surgery; Neurolysis

Figure

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  Fig. 1. Intraoperative photographs of case 7. (A) A standard incision described by Taleisnik; a reformed transverse carpal ligament was observed (black arrow). (B) External neurolysis involves freeing the median nerve from an adhesion; palmaris longus tendon was transected for opponensplasty.

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  Fig. 2. Intraoperative photograph of case 4. After external neurolysis, hourglass constriction of median nerve was observed.

Reference

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