Complications of surgical treatment and relapses of carpal tunnel syndrome

   Abstract: This work is devoted to the analysis of the reasons for the unsatisfactory results of surgical treatment of carpal tunnel syndrome. On the basis of literature data, as well as our own clinical observations, conclusions are drawn about the most common causes, the role of ultrasound examination in their detection and prevention is substantiated.

   Objective: To identify the causes of unsatisfactory results in surgical treatment of carpal tunnel syndrome.

   Materials and Methods: A retrospective assessment of 16 cases of unsatisfactory treatment results for carpal tunnel syndrome was carried out, requiring repeated surgical intervention in the period 2016–2019. In the study, there were 2 men (12.5 %), women – 14 (87.5 %), patients’ age from 35 to 72 years. Inclusion criteria: persistence of complaints (pain, impaired sensitivity, decreased strength in the hand) after 1 year of surgery for carpal tunnel syndrome, indications for surgical treatment. Exclusion criteria: the presence of degenerative-dystrophic changes in the cervical spine, no indications
for surgical treatment.

   Results: Among the reasons for the unsatisfactory results of treatment of the carpal tunnel syndrome were identified: incomplete dissection of the ligament (n = 11), non dissection of the ligament (n = 3), damage to the branches of the median nerve (n = 1), damage to the nerve trunk as a result of neurolysis (n = 1)). The regression of the severity of symptoms and functional dysfunction assessed on the SSS and FSS scales was: SSS – с 3,09–3,9 до 1,27–1,5, FSS – с 2,25–3,38 до 1,25–1,5, p < 0,05.

   Conclusion: The most common reason for unsatisfactory results of surgical treatment of carpal tunnel syndrome is insufficient knowledge of the anatomy and technique of surgical interventions. Repeated surgical interventions for decompression of the median nerve in the carpal tunnel give significantly worse results than primary decompression. The priority direction in the development of this topic should be the systematization of the available scattered data on the results of treatment of carpal tunnel syndrome and the creation of a unified algorithm for a personalized approach to diagnosis and the choice of a method of surgical treatment.

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