Revision Carpal Tunnel Release in a Case of Persistent Symptoms and Incomplete Release 2 Mackinnon SE1 Yee A1 November 18, 2013Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.Failure to resolve symptoms of carpal tunnel syndrome following a release of the flexor retinaculum can occur for a number of reasons. Failed carpal tunnel can be classified into three categories and include (1) persistent symptoms, (2) recurrent symptoms, and (3) new symptoms. Persistent symptoms of median nerve dysfunction can imply an incomplete release and/or wrong initial diagnosis with other associated problems, which can include proximal median nerve compression and/or cervical disc disease. Revision surgery is appropriate for patients with an incomplete release. In this case, the patient presented with a loss of median motor/sensory function immediately after surgery and pain in the territory of the palmar cutaneous branch of the median nerve. Provocative tests revealed findings comparable with an incomplete release of the carpal tunnel. Revision surgery was elected and an incomplete proximal release of the flexor retinaculum was found. Additionally, this patient had a palmar cutaneous branch with an aberrant course through the flexor retinaculum into the territory of the first incision. This branch was managed with a proximal transposition.Keywords: revision surgeryincomplete releaserevision carpal tunnel releasecarpal tunnel syndromeflexor retinaculumnerve decompressionfailed carpal tunnel releasetransverse carpal ligament You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:15 - Orientation / Incision / Exposure00:00:49 - Exposure of the Median Nerve Proximal to the Previous Surgery00:01:13 - Exposure / Release of the Proximal Flexor Retinaculum and Antebrachial Fascia00:01:59 - Exposure of the Distal Flexor Retinaculum00:02:12 - Identifying of the Palmar Cutaneous Branch of Ulnar Nerve00:02:31 - Identifying the “V” Intersection between the Thenar and Hypothenar Muscles00:02:57 - Release of the Distal Flexor Retinaculum00:03:20 - Separating the Median Nerve from the Overlying Attachment to the Flexor Retinaculum00:03:36 - Identifying an Aberrant Branch of the Palmar Cutaneous Branch of Median Nerve00:04:53 - Longitudinal Epineurial Neurolysis of the Median Nerve00:06:39 - Transverse Epineurial Neurolysis of the Median Nerve00:07:09 - Proximal Transposition of Cutaneous Branch with Cautery Cap and Proximal Crush00:07:52 - Inspection of Median Nerve Following Release00:08:26 - Demonstration of the Recurrent Thenar Motor Branch of Median Nerve You must login to view the full article and extended video on this page. 1 Comment Dimitrios Galanis 1st August 2017 Incredible work you do there and extremely student-orientated material you provide ! Wow, as simple as that ! Log in to Reply | Leave a Comment Cancel replyYou must be logged in to post a comment.