title: Role of pronator release in revision carpal tunnel surgery.
abstract: BACKGROUND
  The purpose of this study was to compare the result of treatment of patients with failed primary carpal tunnel surgery who suspected pronator teres syndrome (PTS) by performing revision carpal tunnel release (CTR) with pronator teres release (PTR) and revision CTR alone.
  
  
  METHODS
  Retrospective chart review in patients who required revision CTR and suspected PTS. Group 1, treated by redo CTR with PTR and group 2, treated by redo CTR alone. Intraoperative findings, pre and postoperative numbness (2-PD), pain (VAS score), and grip strength were studied.
  
  
  RESULTS
  There were 17 patients (20 wrists) in group 1 and 5 patients (5 wrists) in group 2. Patients in group 1 showed more chance of fully recovery of numbness and pain than group 2 (60% vs. 0%, p < 0.05 and 55.0% vs. 0%, p < 0.05, respectively). Mean grip strength was increased 16.0% in group 1 and increase 11.7% in group 2. Most common pathology at the elbow were deep head of pronator teres 90% (18/20 elbows) and lacertus fibrosus 50% (10/20 elbows). The most common finding at carpal tunnel was the reformed transverse carpal ligaments (80%, 20/25 wrists) and scar adhesion around the median nerve (40%, 10/25 wrists).
  
  
  CONCLUSIONS
  Intraoperative findings from our study confirmed that there were pathology in both carpal tunnel and pronator area in failed primary CTR with suspected PTS. Our study showed that combined PTR with revision CTR provided higher chance of completely recovery from numbness and pain more than redo CTR alone.
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University 1873 Rama 4 Road 10330 Pathumwan, Bangkok Thailand.
authors.forename: Pobe
authors.initials: P
authors.lastname: Luangjarmekorn
authors.affiliation: Christian M Kleinert Institute for Hand and Microsurgery 225 Abraham Flexner Way, Suite 850 40202 Louisville KY USA.
authors.forename: Tsu Min
authors.initials: TM
authors.lastname: Tsai
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University 1873 Rama 4 Road 10330 Pathumwan, Bangkok Thailand.
authors.forename: Sittisak
authors.initials: S
authors.lastname: Honsawek
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University 1873 Rama 4 Road 10330 Pathumwan, Bangkok Thailand.
authors.forename: Pravit
authors.initials: P
authors.lastname: Kitidumrongsook
keywords: Carpal tunnel; Decompression; Pronator release; Pronator syndrome; Revision