Recurrent carpal tunnel syndrome: Evaluation and treatment of the possible causes

Figure 1 Mini open incision method. A: Local anesthetic application to the incision line; B: The standard incision starts from the distal volar wrinkle, passes between the thenar and hypothenar region 2-3 mm medially to thenar wrinkle and extends 2-3 cm distally to the lateral side of the third finger; C: Placement of the skin retractor after sharp dissection.

Figure 2 Extended mini-open incision technique in a patient previously operated on using the uniprotal endoscopic method. A: Endoscopic portal scar over the distal wrist wrinkle (red arrow); B: Incomplete incision of the transverse carpal ligament and compression on the median nerve (black arrow); C: The incision is completed and the median nerve is fully decompressed.

Figure 3 Ten (43. 4%) recurrent cases were previously operated with closed technique (uniprotal endoscopic technique in four, biportal endoscopic technique in four and retinaculotomy technique in two cases). Six (26%) recurrent cases were previously operated with open surgical method and seven (30.4%) recurrent cases were previously operated with transverse mini incision.

Figure 4 Thenar atrophy in 14 (60. 8%) cases. Phalen test was positive in 13 (56.5%) cases. Tinel sign was found in 16 (69.5%) cases. Loss of hand strength in 13 (56.5%) cases, nocturnal pain in 18 (78.2%) cases and sensory impairment was detected in 16 (69.5%) cases.