Re-Exploration Carpal Tunnel Surgery for Iatrogenic Median Nerve Injuries

Carpal tunnel syndrome (CTS) is the most prevalent peripheral nerve entrapment disorders of the upper limb worldwide, making carpal tunnel release (CTR) one of the most frequently performed procedures. While CTR is typically successful, a small but important subset of patients may experience failure of the initial surgery, presenting with persistent, recurrent, or new symptoms that may necessitate re-exploration.

This case series details four patients who were referred to a single Plastic Surgeon in Melbourne Australia, with concerning new or persistent symptoms following initial CTR. For each patient, the primary CTR was indicated due to severe, unrelieved symptoms of CTS that were refractory to conservative treatment.

CTR is generally a highly effective procedure with positive outcomes for most patients. However, in some cases, symptoms can remain unresolved or may even worsen postoperatively. Prompt identification and referral of these patients are crucial to achieve optimal outcomes. For those whose symptoms persist or worsen, exploratory surgery may be indicated for two primary reasons: (1) an incomplete release is suspected, or (2) injury to the median or palmar cutaneous nerve is likely. When exploratory surgery is considered, it should ideally be performed by a reconstructive microsurgeon. Early referral post-CTR is essential, enabling timely re-exploration and, if necessary, simultaneous definitive reconstruction, thereby improving the likelihood of successful resolution of symptoms.