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recurrence carpal tunnel syndrome

Can the carpal tunnel syndrome recur after a surgery?

The possibility, that the compression of the nerve occurs again, remains also with the correct surgical technique. The new compression can occur, e.g. if excessive scarring takes place after the surgery. The doctor speaks of a recurrence carpal tunnel syndrome. (Recurrence of the carpal tunnel syndrome)

Sometimes, because of a “recurrence”, a second operation is necessary. Especially if a part of the carpal roof is intact and compression continues.

Other causes for a “recurrence” are:

Severe proliferation of the tendon sheaths, e.g. with rheumatism or dialysis patients (artificial kidney) or the growth of a tumour in the carpal canal.

carpal tunnel recurrence
excessiv scaring as a reason for carpal tunnel recurrence

The illustration shows the surgery of a recurrence carpal tunnel syndrome. Regards the extensive scarring (arrows) above the median nerve, located in the carpal tunnel.

Such recurrence surgeries at the carpal canal can be very challenging pocedure from a surgical point of view.

How does a doctor recognize, if a recurrence of  carpal tunnel syndrome occurs?

In the typical case of a successful carpal tunnel release, the patient recognizes a significant improvement of pain during night. Other, surgery related complaints can remain for a longer period.

If the nightly complaints do not improve or recurrences after some month or years of no pain, a recurrence of a carpal tunnel syndrom needs to be considered.

What method is most reliable in the diagnostic of a recurrence?

Very valuable in the diagnostic of a recurrence is the neurologic measurement ENG and EMG. Especially if the measured values can be compared with the values from before the surgery.

But also for the diagnostic of a recurrence:

All clinical examination reports make a correct diagnosis possible.

Does an increased velocity of the nerve conduction during the neurologic examination mean a recurrence carpal tunnel Syndrome?

No! Such a value is ambiguous. Even with an advanced carpal tunnel syndrome “abnormal” values are frequently found after the surgery. This means an incomplete recreation of the nerve, which is not synonymous with a recurrence! Be aware, that also during a long time and appropriate surgery of a carpal tunnel syndrome, the values estimated with the ENG and EMG often not normalise!

Is it necessary to undergo a surgery again with a recurrence?

This depends on the individual case. The experienced hand surgeon will assess the need for a surgery with the complaints, the chance of success and the risks of a surgery. It is important to also consider other possible reasons for the reoccuring complaints, for example:

  • Nerve pressure in the spine
  • Nerve pressure in the area of the arm’s plexus in the shoulder (e.g. the Thoracic outlet syndrome)
  • Nerve pressure in the fore arm, close to body (Pronator-teres-syndrome)
pronator mescle
median nerv compression in the forearm

The  median nerve can not only be compressed (entrapped) in the carpal tunnel (red arrow) but also at it’s break through in the pronator teres muscle .

This is then called pronator teres syndrome.

The structure shown in the illustration is the median nerve. Two typical pressure points are highlighted:

  • The carpal tunnel (red arrow)
  • The pronator tunnel (blue arrow)

Is the risk higher with the second surgery than with the first surgery?

Yes! Even though the risk is, in terms of quality, the same risk as during the first surgery, the possibility of certain complications occuring is significantly higher with the second surgery.

Where should such a second surgery be performed?

In my opinion, such a second surgery should only be performed by an experienced hand surgeon with knowledge about microsurgical techniques. It should also be considered if the second surgery is taking place as an inpatient treatment.

 Can the second surgery be performed with the endoscopic technique?

No! A second surgery must always be performed with the open technique. Mostly, a longer cut than with the first surgery is needed.

What is the most common reason for a carpal tunnel recurrence?

The by far most common reason is an incomplete split of the carpal roof. In the strict sense of the word carpal tunnel recurrence, the recurrence is not relapse (recurrence), but a continuation of the carpal tunnel syndrome!

median nerv
intra operative view of a recurrent carpal tunnel syndrom

The illustration shows a median nerv how it look like during surgery:

The roof of the carpal canal is fully split! The median nerv is severly damaged.