[Analysis of the causes of failure in carpal tunnel syndrome surgery and the results of reoperation].

OBJECTIVES: We investigated the causes of failure and ensuing problems and findings in patients with unrelieved or recurrent carpal tunnel syndrome (CTS) and evaluated the results of revision surgery. METHODS: The study included 26 patients (21 women, 5 men; mean age 52 years; range 30 to 71 years) who underwent reoperation for unrelieved or recurrent symptoms following at least a year (range 1 to 4 years) after the initial surgery. A total of 34 operations had been carried out in 31 hands. All patients were investigated clinically and electrophysiologically. The mean follow-up after reoperation was 19 months (range 12 to 38 months). RESULTS: The diagnosis was confirmed in all patients by clinical and electrophysiologic studies. The primary operations had been performed using 11 transverse incisions, three incisions confined proximally to the wrist crease, 10 incisions without insufficient distal extension, and seven appropriate incisions. The transverse carpal ligament release was inadequate in 23 hands; it had not been released in three hands at all. Excessive fibrous tissue developed in one patient, leading to complete bilateral median nerve compression. Bilateral and unilateral tenosynovitis resulting from rheumatoid arthritis and tuberculosis was detected in two patients, respectively. All patients underwent repeat open carpal tunnel release. Neurolysis and tenosynovectomy were performed in both hands of one patient and in one hand of two patients, respectively. Clinical results were excellent in 24 hands, good in six hands, and fair in one hand. CONCLUSION: Selection of appropriate incision and achievement of complete carpal tunnel release without any injury to the median nerve or its branches are of great importance with regard to postoperative results. Careful imaging studies of the carpal tunnel should be carried out especially in patients with unilateral involvement, presenting with an atypical age or occupation.