Houston Methodist. Leading Medicine

Hand FAQ

Question:

I had a carpal tunnel release surgery that didn't do the trick. I still have hand pain and thumb and finger numbness. The surgeon wants to go back in and repeat the procedure. If it didn't work the first time, what guarantee do I have that it will work a second time?

Answer:

Studies show that the number one reason for persistent or recurrent symptoms after carpal tunnel release surgery is an incomplete decompression. That means the retinaculum (band of tissue that goes across the wrist and puts pressure on the nerve) is cut but not all the way through. This doesn't happen very often, but it is usually easily rectified by repeating the surgery to get a complete release of the retinaculum. The surgeon will recommend a second (revision) surgery when all indications are that there was an incomplete release. Tests and measures must rule out the possibility of injury to the nerve during the first operation as a cause for your current symptoms. There are two ways of identifying intraoperative nerve damage. One is to conduct electrodiagnostic tests. These help measure nerve function (i.e., how well the nerve is transmitting signals or messages). Before and after electrodiagnostic tests can be compared to see if there has been some additional nerve damage. A second surgery may be needed to repair any nerve damage. A second factor to consider when determining whether or not there has been additional injury or trauma to the nerve is the timing of the symptoms. Symptoms that never really went away after surgery suggest persistent carpal tunnel syndrome. And again, the most common reason for that situation is an incomplete decompression. Symptoms that went away but later came back point to the possibility of fibrosis (scar tissue build up around the nerve). Sometimes it's not possible to know for sure what's going on until the surgeon goes back into the carpal tunnel area and takes a look around. The retinaculum can be re-released if needed and the nerve can be inspected for any scarring, trauma, or other damage. Don't hesitate to ask what your surgeon thinks is causing your continued symptoms and why a second operation is necessary. Peter C. Amadio, MD. Interventions for Recurrent/Persistent Carpal Tunnel Syndrome After Carpal Tunnel Release. In The Journal of Hand Surgery. September 2009. Vol. 34. No. 7. Pp. 1320-1323.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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