Predicting the Outcome of Revision Carpal Tunnel Release

Complications of Compressive Neuropathy

“…47,48 Standard provocative maneuvers, including carpal compression and wrist flexion testing may confirm the diagnosis of CTS, and provide information regarding the etiology of symptoms. (Table 2) 35,49,50 Although response to steroid injection has been shown to be well correlated with relief among patients with primary carpal tunnel syndrome, its utility among patients with recurrent or persistent symptoms is less clear. 51 Recent evidence suggests that relief from steroid injection combined with positive provocative physical examination findings are predictive of relief for patients undergoing revision CTR for recurrent symptoms.…”

“…51 Recent evidence suggests that relief from steroid injection combined with positive provocative physical examination findings are predictive of relief for patients undergoing revision CTR for recurrent symptoms. 50 …”

Probability and Pathophysiology

“…1 The presence of baseline changes should not, in our opinion, be an absolute contraindication to revision surgery. No patient was operated on for a primary report of pain.…”

Revision Carpal Tunnel Surgery: A 10-Year Review of Intraoperative Findings and Outcomes

“…Outcomes following revision carpal tunnel surgery are generally found to be worse than primary surgery, with less success in alleviating patient symptoms (14)(15)(16). However, most prior outcome studies of secondary CTR have focused on specific surgical techniques, such as the use of biologic or synthetic barriers for median nerve coverage, and have been limited by small sample size and poor application to wide groups of patients (13,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…However, most prior outcome studies of secondary CTR have focused on specific surgical techniques, such as the use of biologic or synthetic barriers for median nerve coverage, and have been limited by small sample size and poor application to wide groups of patients (13,15,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The objectives of this study were fourfold: 1) to describe the patient population undergoing secondary carpal tunnel surgery in a high-volume tertiary peripheral nerve center; 2) to relate patients' presenting symptoms (persistent/recurrent/new) to intra-operative findings; 3) to evaluate outcomes of revision CTR, including strength and pain measures, and their relationship to symptom classification; and, 4) to identify predictors of postoperative pain following revision surgery.…”