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Review
. 2023 Jun 9;5(4):510-518.
doi: 10.1016/j.jhsg.2023.05.008. eCollection 2023 Jul.

Management of Failed Carpal and Cubital Tunnel Release: An Evidence-Based Guide to Success

Andrew K Ence  1 , Brent R DeGeorge Jr  1   2
Affiliations
Review

Management of Failed Carpal and Cubital Tunnel Release: An Evidence-Based Guide to Success

Andrew K Ence et al. J Hand Surg Glob Online. .

Abstract

Carpal tunnel and cubital tunnel syndromes are the most common compressive neuropathies of the upper extremity with surgical treatment having high success rates for both conditions. Although uncommon, persistent or recurrent carpal and cubital tunnel syndrome presents a challenge for patients and providers. Diagnosis of persistence versus recurrence of the pathology is key in establishing an appropriate treatment plan to provide the best possible patient outcomes. After an established diagnosis, a wide array of treatment options exist which varies based on previous procedures performed. This review discusses relevant anatomy, etiology, and clinical presentations of persistent and recurrent carpal and cubital tunnel syndromes. The range of treatment options is presented based on history and diagnostic findings. Treatment options span from revision of nerve decompression to the use of soft tissue rearrangement procedures. Some specific treatment options discussed include simple revision nerve decompression, external neurolysis, soft tissue rearrangement, such as the hypothenar fat flap or various transposition techniques, and the use of nerve wraps. Included is an evidence-based management guide for diagnosis and treatment of persistent versus recurrent carpal and cubital tunnel syndromes.

Keywords: Carpal tunnel syndrome; Cubital tunnel syndrome; Nerve compression.

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Figures

Figure 1
Figure 1
Intraoperative image of MN following revision decompression and external neurolysis.
Figure 2
Figure 2
Intraoperative image of revision MN decompression with collagen nerve wrapping.
Figure 3
Figure 3
Intraoperative image of revision MN decompression showing dissection of hypothenar fat flap.
Figure 4
Figure 4
Intraoperative image of revision MN decompression with transposition of hypothenar fat flap.
Figure 5
Figure 5
Algorithm for management of failed primary CTS procedures. RCTR, revision carpal tunnel release; CNW, collagen nerve wrap; EN, external neurolysis; HFF, hypothenar fat flap.
Figure 6
Figure 6
Algorithm for operative management of failed primary CuTS procedures. ASCT, anterior subcutaneous transposition; ASFT, anterior subfascial transposition; CNW, collagen nerve wrap; EN, external neurolysis.
Figure 7
Figure 7
Intraoperative image of revision UN decompression with significant edema of the UN.
Figure 8
Figure 8
Intraoperative image of revision UN decompression following anterior subfascial transposition.
See this image and copyright information in PMC

References

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