Management of Recurrent Carpal Tunnel Syndrome: Systematic Review and Meta-Analysis

Cadaveric Study of Thread Carpal Tunnel Release Using Newly Developed Thread, With a Histologic Perspective

“…The most common cause is the incomplete release of the TCL, and the second common is circumferential fibrosis around the median nerve [13]. Approximately 2%-10% of patients are reported to experience recurrent CTS, and efforts have been made to reduce the incidence of recurrent CTS [14,15].…”

Recalcitrant Neuropathies in the Upper Extremity

“…The flap is supplied by branches directly from the ulnar artery and branches of the ulnar artery to the small finger, the fourth webspace, and hypothenar muscles. In the meta-analysis by Jensen et al, 4 there was a significant improvement in the Boston Carpal Tunnel Questionnaire symptom severity and functional status scale in patients receiving a hypothenar fat pad flap. Regarding the improvement size between the hypothenar fat pad flap group, the decompression-only group, the autologous fat transfer group, and the “other” group, there was a trend toward a greater improvement when using the hypothenar fat pad flap to treat recurrent CTS.…”

“…The weighted success rate of these nine studies, which included 364 patients, was 75%. 17 Similarly, in a meta-analysis of treatment outcomes for patients with recurrent CTS by Jansen et al, 4 patients undergoing open decompression with or without neurolysis showed significant improvement as measured by the Boston Carpal Tunnel Questionnaire symptom severity and functional status scale.…”

“…Regarding the improvement size between the hypothenar fat pad flap group, the decompression-only group, the autologous fat transfer group, and the “other” group, there was a trend toward a greater improvement when using the hypothenar fat pad flap to treat recurrent CTS. 4 Likewise, in the meta-analysis of Soltani et al, 17 the flap group, which included the hypothenar fat pad flap and other pedicled and free flaps, demonstrated a success rate of 86%, significantly higher than the non-flap group. Factors associated with worse outcomes after a hypothenar fat pad flap include involvement of the nondominant hand, recurrence within a year from the previous surgery, scar tissue in the carpal tunnel, obesity, diabetes mellitus, and cervical spine problems.…”

“…Approximately 2% to 10% of patients require carpal tunnel revision surgery, while rates of revision surgery for cubital tunnel syndrome are 12% to 25%. 4 , 5 In this review, we discuss the etiology, surgical techniques, and associated outcomes of recalcitrant carpal and cubital tunnel syndromes.…”