title: Revision surgery for recurrent and persistent carpal tunnel syndrome: Clinical results and factors affecting outcomes.
abstract: Thirty-eight hands in 36 patients with recurrent or persistent carpal tunnel syndrome (CTS) were reviewed retrospectively after a mean of 51 months (range 12-86) to identify factors that may lead to poor outcomes after surgical management. Clinical assessment focused on pain and sensitivity recovery, measured with a VAS and Weber's two-point discrimination test, respectively. At the latest follow-up, we found 11 excellent, 15 good, nine fair and three poor results. The risk of fair or poor results was significantly higher in the presence of intraneural fibrosis, severe preoperative sensory deficit, neuroma of the palmar cutaneous branch of the median nerve, workers compensation claims and number of previous surgeries. This last factor also significantly increased the risk of intraneural fibrosis. Despite disappointing outcomes, identification of these factors may improve our prognostic ability for revision surgery in cases of recurrent CTS.
authors.affiliation: Service de chirurgie de la main et du membre supérieur et chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: iskander.djerbi@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Djerbi
authors.affiliation: Service de chirurgie de la main et du membre supérieur et chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: César
authors.affiliation: Service de chirurgie de la main et du membre supérieur et chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: H
authors.initials: H
authors.lastname: Lenoir
authors.affiliation: Service de chirurgie de la main et du membre supérieur et chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: B
authors.initials: B
authors.lastname: Coulet
authors.affiliation: Service de chirurgie de la main et du membre supérieur et chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Lazerges
authors.affiliation: Service de chirurgie de la main et du membre supérieur et chirurgie des paralysies, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
authors.forename: M
authors.initials: M
authors.lastname: Chammas
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D005260:Female; D005355:Fibrosis; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000473:pathology; D008875:Middle Aged; D009460:Neurologic Examination; D009463:Neuroma / Q000150:complications; D010524:Peripheral Nervous System Neoplasms / Q000150:complications; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D064232:Visual Analog Scale; D014942:Workers' Compensation / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Canal carpien récidivant; Facteurs pronostiques; Fibrose intraneurale; Fibrose périneurale; Hypothenar flap; Intraneural fibrosis; Lambeau hypothénarien; Lambeau synovial; Median nerve; Nerf médian; Neuroma of the palmar cutaneous branch of the median nerve; Névrome de la branche cutanée palmaire du nerf médian; Perineural fibrosis; Persistent carpal tunnel syndrome; Prognostic factors; Recurrent carpal tunnel syndrome; Syndrome du canal carpien persistant; Synovial flap