Failed carpal tunnel surgery: A guide to management

Revision surgery constitutes up to 2.7% of cases of carpal tunnel surgery in the UK. Failed carpal tunnel surgery can present as deterioration, recurrence or persistence of symptoms after surgical decompression. The causes of failed carpal tunnel decompression can often be categorised into four groups; poor surgery, poor nerve, poor diagnosis or poor luck. This situation calls for a structured review of the clinical history, examination, previous investigations and subsequently devising a management plan. We reviewed relevant articles on PubMed, Medline, Embase and Ovid, and we provided a structured approach to failed carpal tunnel surgery based on the current evidence. There are several options for revision carpal tunnel surgery that can be implemented to protect the median nerve, including local flaps, collagen and synthetic polymer wraps. A majority of patients experience improvement in symptoms after revision surgery.