Treatment options for recurrent carpal tunnel syndrome: Local flaps

Idiopathic carpal tunnel syndrome (CTS) has become one of the most common peripheral neuropathies of the upper extremity in the United States, and carpal tunnel release is one of the most commonly performed surgeries of the hand. Primary surgical release of median nerve compression at the wrist usually affords good symptomatic relief, but a small but significant number of surgical failures exist. Before committing to surgery, aggressive nonsurgical management should be exhausted. Significant benefits from splinting, ultrasound, nerves gliding exercises, and carpal bone mobilization have been obtained in mild to moderate primary carpal tunnel, and similar therapy may prove beneficial for a patient with recurrent symptoms. If refractory to aggressive conservative management and objective evidence exists to support recurrent CTS, then the etiology of recurrent carpal tunnel syndrome may include incomplete release of the transverse carpal ligament, fibrous proliferation, and recurrent tenosynovitis. Many techniques are available to treat the condition. Treatment can range from a simple strait forward approach to a complex constellation of procedures including external and internal neurolysis and vascularized flap coverage. The purpose of this chapter is to describe the etiology of recurrent CTS lending support for an appropriate treatment plan to address the pathology. In all cases, the objective is to provide a favorable environment for the median nerve in which normal excursion is possible.