Failure to resolve symptoms of carpal tunnel syndrome following a release of the flexor retinaculum can occur for a number of reasons. Failed carpal tunnel can be classified into three categories and include (1) persistent symptoms, (2) recurrent symptoms, and (3) new symptoms. Persistent symptoms of median nerve dysfunction can imply an incomplete release and/or wrong initial diagnosis with other associated problems, which can include proximal median nerve compression and/or cervical disc disease. Revision surgery is appropriate for patients with an incomplete release. In this case, the patient presented with a loss of median motor/sensory function immediately after surgery and pain in the territory of the palmar cutaneous branch of the median nerve. Provocative tests revealed findings comparable with an incomplete release of the carpal tunnel. Revision surgery was elected and an incomplete proximal release of the flexor retinaculum was found. Additionally, this patient had a palmar cutaneous branch with an aberrant course through the flexor retinaculum into the territory of the first incision. This branch was managed with a proximal transposition.
Ulnar incision from thenar crease, Brunner’s incision over wrist crease, and proximal forearm incision.
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