Revision Carpal Tunnel Release: Risk Factors and Rate of Secondary Surgery

Abstract

Background: The first aim of this study was to determine the rate of revision carpal tunnel release in five urban hospitals over a period of 14 years. The secondary aim was to assess what demographic, condition-related, and treatment-related factors are associated with revision carpal tunnel release. Methods: Between 2002 and 2015, 7464 patients underwent carpal tunnel release. After manually reviewing the medical records, the authors identified 113 patients who underwent revision surgery. Multivariable logistic regression analysis was performed to study association with demographics (age, sex, and race), unilateral or bilateral treated wrist(s) (including carpal tunnel release performed simultaneously and separately), and type of surgery (open or endoscopic). To gain further insight into these factors, a matched case-control analysis in a 1:3 ratio was performed. Results: One hundred thirteen of 7464 patients (1.5 percent) underwent revision carpal tunnel surgery. The median (interquartile range) time to revision surgery was 1.23 years (0.47 to 3.89 years). In multivariable logistic regression analysis, older age, male sex, bilateral carpal tunnel release, and endoscopic carpal tunnel release were independently associated with higher odds for revision surgery. Multivariable conditional logistic regression of the matched case-control cohort showed that smoking and rheumatoid arthritis were independently associated with revision carpal tunnel release. Splint treatment before the initial surgery was independently associated with single carpal tunnel release. Conclusion: Endoscopic release, male sex, smoking, rheumatoid arthritis, and undergoing staged or simultaneous bilateral carpal tunnel release are risk factors for revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review

“…There is a lack of representation of CTS patients with diabetes in the studies given their high prevalence and the possibility of developing CTS throughout their lives. Moreover, the conservative approach should be more studied in this subgroup as it can be more difficult to diagnose CTS in patients with diabetes because the earliest symptoms can be mistaken for diabetic polyneuropathy [64], and controversy exists about surgical treatment for these patients [65]. Given the lack of representation of patients with CTS and systemic diseases in the studies dealing with conservative therapy approaches, we consider this type of patients should be included in the sample selection criteria in studies on conservative treatment for CTS.…”

High-resolution sonographic study of the communicating branch of Berrettini: an anatomical feasibility study

“…Carpal tunnel release is a common and reliable operation with satisfactory clinical results. However, revision surgery is required in in 5-10% of patients (Westenberg et al, 2020). Repeated decompression with or without external or internal neurolysis has been reported as the standard technique (Stirling et al, 2020;Unglaub et al, 2008).…”

Standard incision and median nerve external neurolysis for recalcitrant carpal tunnel syndrome

“…ported in the literature, ranging from simple release to those using complicated flaps and interposing tissue [6,8,10,11]. These perioperative challenges affecting patient consultation are also encountered when opting for the simplest techniquenamely, repeated decompression without added proceduresdue to the limited number of studies exclusively addressing its outcomes [6,12].…”