[Recurrent carpal tunnel syndrome--caused by an inadequate surgical technique?]

The carpal tunnel syndrome (CTS) is a common disease, and the decompression of the median nerve is one of the most often performed procedures in surgery. Within our patients from the 1. 12. 1987 to the 1. 12. 1988 we found 16 cases of recurrent CTS. Intraoperatively in more than 60% of the cases we could detect some sort of subluxation or even luxation of the median nerve and severe scarring involving the median nerve and the regenerated transverse carpal ligament in all cases. Considering the anatomy of the transverse carpal ligament, to guide the median nerve and the flexor tendon within the carpal tunnel, as well as serving as origin for the thenar musculature, especially for the opposition, one concludes that the simple dissection of the carpal ligament should be avoided. For the past 4 years we therefore have been performing a widening Z-plasty and reconstruction of the transverse carpal ligament, for the primary CTS as well as for revisions. The favorable postoperative results seem to confirm our theory. We discuss our operative technique as well as the results in CTS revision cases.