title: Surgical options for recalcitrant carpal tunnel syndrome with perineural fibrosis.
abstract: Surgical release of the transverse carpal ligament for the treatment of carpal tunnel syndrome (CTS) is, in general, a very successful procedure. Some patients, however, fail this standard release and have persistent or recurrent symptoms. Such recalcitrance may relate to incomplete release but more often relates to perineural or intraneural fibrosis of the median nerve. While there is no good treatment for intraneural fibrosis, numerous procedures have evolved in an attempt to treat perineural fibrosis which restricts nerve gliding. These include procedures to isolate the nerve from scar as well as procedures to bring neovascularization to the median nerve. This review describes the various surgical treatment options for recalcitrant CTS as well as their reported outcomes.
authors: Department of Orthopaedics, University of Maryland School of Medicine, 1 Texas Station Ct., Suite 300, Timonium, MD 21093 USA.
authors: Joshua M
authors: JM
authors: Abzug
authors: Sidney M
authors: SM
authors: Jacoby
authors: A Lee
authors: AL
authors: Osterman
keywords: Carpal tunnel release; Carpal tunnel syndrome; Recalcitrant carpal tunnel syndrome; Revision carpal tunnel