[Repetitive release of the medial nerve in the carpal tunnel. Analysis of a series of 18 cases].
OBJECTIVE
This study analyzes 18 revision procedures for carpal tunnel release failure.


METHODS
This series did not present any difference in terms of age compare to the population suffering from median nerve entrapment: mean age 56 years, 17 female and 1 male, 1 monolateral syndrome and 8 bilateral. Two third of the patients were seen between 2 and 9 months after initial surgical treatment. Most of the first surgical procedures were performed by an orthopedic surgeon (12/18). The approach was open (14/18) with 5 short incisions, and 4 endoscopic releases. Clinical symptoms were worse or unchanged compare to prior to surgery. All the patients had EMG study and 15 had worse electric signs than before. Open surgical approach was always palmar using optic magnification for median nerve neurolysis.


RESULTS
16 times an incomplete section of the anterior retinaculum and 2 median nerve lacerations were found. All patients were seen with a follow up of more than 2 months. Results concerning pain and sensibility were good for 16 of them; regarding motor impairment, only 13 of them had a good result. Grasp was not improved for 50 per cent of them. Two patients had a result considered as bad (one NAD sequela and one median total laceration).


CONCLUSIONS
In our series as well as in literature, failures of carpal tunnel release are due to incomplete section of the anterior retinaculum and sometimes to median nerve laceration. The second look has to be performed when there is no improvement or when the situation is worse after initial surgery.


CONCLUSIONS
Incomplete section of the anterior retinaculum is the most frequent reason for carpal tunnel release failure. An EMG seems necessary to confirm diagnosis before revision surgical procedure.
Département d'Orthopédie, CHU, Caen.
J L
JL
Condamine
L
L
Marcucci
M H
MH
Rosas
M
M
Fourquet
D
D
Pichereau
D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000503:physiopathology / Q000601:surgery*; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome
Libération itérative du nerf médian au canal carpien. Analyse d'une série de 18 cas.