gms | German Medical Science

Objectives/Interrogation: A direct approach is the standard procedure for the treatment of recurrent carpal tunnel syndrome. However, this may be technically challenging due to adhesions and an increased risk of iatrogenic injuries. Endoscopic release of the median nerve within the carpal tunnel has become a well-controlled procedure, providing better anatomical vision than the conventional technique, thanks to the advances in technology. The aim of this work is to study the interest and feasibility of endoscopic release in the event of carpal tunnel recurrence.

Methods: Seven patients, with a mean age of 61 years old, presented a clinical symptomatology of carpal tunnel syndrome after an average of 6 years following initial surgery for median nerve release, by mini-open surgery in 6 patients and endoscopic surgery in one patient. Electromyography was positive in all patients and confirmed the recurrence. All patients were treated with endoscopic carpal tunnel revision surgery. They were informed of the risk of conversion to open surgery and all were reviewed and clinically evaluated.

Results and Conclusions: Endoscopic release was successfully performed except in one case in which the anterior carpal retinaculum did not deviate sufficiently in its distal part due to its thickness. We undertook an open conversion to complete the release. In all cases, the anatomical elements were visualized in order to protect them before section of the anterior carpal retinaculum. All patients were satisfied and reported an improvement in symptomatology.

Recurrence after carpal tunnel surgery is rare and should trigger a search for incomplete release in the majority of cases. Open surgery is the most commonly used technique and some authors advocate neurolysis of the median nerve associated with a protection flap as required. The interest of endoscopy is to visualize all the anatomical parts such as the median nerve, flexor tendons and the superficial palmar arch, in order to protect them before safely cutting the anterior retinaculum on its ulnar side, unlike with the open approach. Neurolysis exposes the patient to a risk of iatrogenic nerve damage. We believe that, for a first recurrence, it is sufficient to perform a simple release without any associated procedures. This study shows that endoscopic release of recurrent carpal tunnel can be safely performed with good results. Mastering the endoscopic technique is essential and reverting to open surgery must be the rule for cases with difficult visibility.