Recurrent carpal tunnel syndrome

Recurrent symptoms of CTS have been shown to occur in 0% to 19% of patients following CTR, with up to 12% requiring re-exploration. Common causes of recurrent CTS are incomplete release of the TCL, fibrous proliferation, or recurrent tenosynovitis. The prognosis for re-exploration is fair; improvement can be achieved in many cases, but prognosis is not as favorable as in primary CTR. The most predictable improvement seems to be in patients with CTS caused by granulomatous infections, in which proper surgery and medical therapy can usually result in a satisfactory outcome. For the heavily scarred carpal tunnel with fibrous proliferation, many operative options are available. These procedures include external nerve lysis and mobilization, followed by application of local muscle flaps, fat grafts, or vein wrapping. There appear to be higher recurrence rates and poorer outcomes in patients with occupation-related CTS.