Related Experiment Video
Updated: Aug 1, 2025
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Recurrent carpal tunnel syndrome: Outcomes after neurolysis and synovial flap
Guillaume Bollmann1, Cindy Bouvet2, Jean-Yves Beaulieu2
1Department of Hand Surgery, Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva 14, Switzerland; Department of Anatomy, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Geneva, Switzerland; Centre Epaule Main Fribourg SA, Rue Hans-Geiler 6, 1700 Fribourg, Switzerland.
Objectives:
If symptoms recur after primary neurolysis of the median nerve, surgical revision is required. Soltani et al. (2013) demonstrated that surgical revision with vascularized flap coverage had a higher success rate (86%) than surgical revision without a flap (75%). The aim of this retrospective study was to present clinical outcomes in 36 cases of secondary open neurolysis of the median nerve, with synovial flap in case of recurrent carpal tunnel syndrome.
Method:
Thirty-three patients (36 hands) who had undergone secondary neurolysis of the median nerve combined with synovial flap coverage between 2012 and 2019 were selected for this study. We included only recurrent carpal tunnel syndrome cases presenting with scarring of the transverse carpal ligament or epineural fibrosis of the median nerve and with a symptom-free period of at least 3 months. The results were ranked on a 4-point scale as excellent, good, null or poor, depending on progression at last follow-up.
Results:
Descriptive analysis showed that 80% of patients had a positive outcome (excellent 33%, good 47%), 6% null outcome and 14% poor outcome.
Conclusion:
This is an interesting, relatively non-invasive surgical option, and should be part of the therapeutic armamentarium for recurrent carpal tunnel syndrome in case of adherence of the nerve to the transverse carpal ligament.
