Abstract
Introduction
Carpal tunnel syndrome is the commonest peripheral nerve compression neuropathy. Carpal tunnel release (CTR) is a very successful operation. Failed CTR mainly presents as persistence of symptoms, recurrence and new symptoms. The commonest presentation is persistence of symptoms suggested to be due to inadequate release of transverse carpal ligament (TCL) [3], and ante brachial fascia (ABF) [2].
Aim
We were looking at the rate of recurrence after CTR and the levels of skills of the primary surgeon.
Materials and method
In a retrospective study we reviewed 49 cases of failed CTR in Kent and Sussex area in the South East of England covering the period between 1978 and 2008. The data was generated from the revision open CTR operation notes following referral to the specialist hand surgeon in the region.
Results
There is 34 female and 13 male with age range of 41 to 90. The time between primary CTR to revision CTR is 3 months to 30 years.
In our series, more than 55% was due to persistence. Incomplete division of TCL was noted in over 55% of cases and intact ABF in 34% of cases. In 49% of cases of recurrent carpal tunnel syndrome post CTR the primary surgery was done by GPs.
Conclusion
This questions the role of GPs with special interest (GPSI) and surgical care practitioners as surgeons. Is this “a tip of the iceberg” This initiative is target driven not patient centred.
