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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(05): 718-725
DOI: 10.1055/s-0040-1713759
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Failure factors for carpal tunnel syndrome surgical treatment: When and how to perform a revision carpal tunnel decompression surgery

Article in several languages: português | English
Carlos Henrique Fernandes 
1   Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
,
João Baptista Gomes dos Santos 
1   Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
,
Francisco Schwartz-Fernandes 
2   USF Health Morsani College of Medicine, Tampa, Flórida, United States
,
A. Lee Ostermann 
3   Hand and Orthopaedic Surgery Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Flávio Faloppa 
1   Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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Abstract

Despite being a procedure widely used all over the world with high rates of symptom remission, surgical treatment of carpal tunnel syndrome may present unsatisfactory outcomes. Such outcomes may be manifested clinically by non-remission of symptoms, remission of symptoms with recurrence a time after surgery or appearance of different symptoms after surgery. Different factors are related to this unsuccessful surgical treatment of carpal tunnel syndrome. Prevention can be achieved through a thorough preoperative clinical evaluation of the patient. As such, the surgeon will be able to make differential or concomitant diagnoses, as well as determine factors related to patient dissatisfaction. Perioperative factors include the correct identification of anatomical structures for complete median nerve decompression. Numerous procedures have been described for managing postoperative factors. Among them, the most common is adhesion around the median nerve, which has been treated with relative success using different vascularized flaps or autologous or homologous tissue coverage. The approach to cases with unsuccessful surgical treatment of carpal tunnel syndrome is discussed in more detail in the text.

Keywords

carpal tunnel syndrome/diagnosis - carpal tunnel syndrome/surgery - carpal tunnel syndrome/complications - recurrence - surgical flaps


Publication History

Received: 20 December 2019

Accepted: 20 April 2020

Article published online:
22 September 2020

© 2020. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

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