From the Guidelines
Carpal tunnel syndrome can recur after treatment, including surgery, with recurrence rates ranging from 10-25% of patients experiencing symptoms again after surgical release. This is based on the findings of a 2021 umbrella review of level 1 evidence published in the BMJ 1, which suggested that while endoscopic and open release are about as effective as each other in relieving symptoms and improving functional status, the risk of recurrence remains a concern. Factors that increase the risk of recurrence include:
- Incomplete release of the transverse carpal ligament during surgery
- Development of scar tissue
- Persistent inflammation
- Continuation of activities that originally caused the condition
- Underlying health conditions like diabetes, rheumatoid arthritis, or thyroid disorders
To minimize the risk of carpal tunnel returning, patients should:
- Maintain proper ergonomics at work and home
- Take regular breaks from repetitive activities
- Perform nerve gliding exercises as recommended by healthcare providers
- Manage any underlying health conditions. If symptoms return, patients should seek medical evaluation promptly, as early intervention with wrist splinting, anti-inflammatory medications, or corticosteroid injections may help prevent progression and potentially avoid the need for revision surgery, as supported by the findings of the selected randomised controlled trials that compared carpal tunnel surgery with non-surgical treatment 1.
From the Research
Recurrence of Carpal Tunnel Syndrome
- Carpal tunnel syndrome (CTS) can recur in some patients after treatment, with recurrence rates ranging from 0% to 19% 2.
- The causes of recurrent CTS can include incomplete release of the transverse carpal ligament (TCL), fibrous proliferation, or recurrent tenosynovitis 2.
- Recurrent CTS can also be caused by systemic diseases such as diabetic polyneuropathy, hypothyroidism, rheumatoid arthritis, and systemic amyloidosis 3.
Treatment and Outcomes
- Re-exploration and surgical treatment can improve symptoms in many cases of recurrent CTS, but the prognosis is not as favorable as in primary CTR 2.
- The overall results of revision carpal tunnel procedures are less successful than primary surgery 4.
- Various surgical options are available for treating recurrent CTS, including external nerve lysis and mobilization, application of local muscle flaps, fat grafts, or vein wrapping 2.
- Early mobilization and interposition of a biomaterial or raising a local flap to surround and protect the nerve can also be used to prevent or diminish recurrent fibrosis 5.