Carpal Tunnel Syndrome - Surgery

Complications and Long-Term Outcome

In spite of the success of carpal tunnel surgery, treatment failure and complication rates range. People should carefully educate themselves about how alternative therapies may interact with other medications or impact other medical conditions and should check with their doctor before trying any of them.

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Postsurgery complications may include the following:

Nerve damage with tingling and numbness (usually temporary, but some people will always experience residual numbness in the fingertips).
Infection.
Scarring.
Pain (the incision site may remain sore for months, and some patients experience some scar pain for years with open release).
Stiffness.
Loss of some wrist strength. Between 10% and a third of patients lose some wrist strength. (Endoscopy may have better results than open release.) Some patients who have jobs requiring high amounts of force to the hand and wrist, then, may not be able to perform them after surgery. Such workers may also have problems in other parts of the upper body, including elbows and shoulders, which are not resolved with surgery and can persist. Studies indicate that between 10 - 15% of patients change jobs after the operation.

If pain and symptoms recur, the release procedure may be repeated. Reasons for failure include:

Incomplete release of the ligament.
Extensive scarring.
Recurrence of the disorder due to underlying medical disorders.

Patients who had open release surgery appear more likely to require repeat operations compared with those who have had endoscopic surgery.

Procedures for Surgical Failure or Recurring Symptoms

Neurolysis. In some severe cases or when scarring is extensive after surgery, surgeons may choose to sever the nerves that are responsible for the pain using a procedure called external or internal neurolysis. The procedure may extend recovery time substantially, and the need for repeat surgeries may be higher in those who undergo the procedure. One report indicated that neurolysis should be considered if there has not been any recovery three months after surgery, after which improvement is unlikely. Nevertheless, it is unclear if this approach offers any benefits beyond conservative measures to free the nerve from surrounding scar tissue.

Implants. In another procedure for recurrent carpal tunnel syndrome, doctors may take muscle flaps or even fatty tissue from other parts of the body and implant them at the site of the nerve injury. Such flaps enhance the development of new blood vessels, provide padding, and possibly serve as a bed for nerve regrowth. These implants may be used with or without nerve dissection. Another procedure called vein wrapping uses grafts taken from veins to help protect the scarred nerves.