Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2018; 6(10): 365-372
Published online Sep 26, 2018. doi: 10.12998/wjcc.v6.i10.365
Recurrent carpal tunnel syndrome: Evaluation and treatment of the possible causes
Ahmet Eroğlu, Enes Sarı, Ali Kıvanç Topuz, Hakan Şimşek, Serhat Pusat
Ahmet Eroğlu, Hakan Şimşek, Serhat Pusat, Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Istanbul 34000, Turkey
Enes Sarı, Department of Orthopaedics and Traumatology, Near East University Hospital, Lefkoşa 99010, Cyprus
Ali Kıvanç Topuz, Department of Neurosurgery, Baypark Hospital, Istanbul 34000, Turkey
Author contributions: Eroğlu A contributed to the idea for research or article/hypothesis generation, supervision and responsibility for the organisation and course of the project and the manuscript preparation; Sarı E planed the methods to generate hypothesis and takes responsibility for creation of the entire or a substantial part of the manuscript; Topuz AK took responsibility for conducting literature search; Şimşek H reworked the final, before submission version of the manuscript for intellectual content, not just spelling and grammar check; Pusat S took responsibility for creation of the entire or a substantial part of the manuscript.
Institutional review board statement: The manuscript has been approved by Ministry of Health Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Review Board of Neurosurgery.
Informed consent statement: It has been declared that all relevant persons involved (subjects or legally authorized representative) gave their informed consent (written or verbal, as appropriate).
Conflict-of-interest statement: All authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahmet Eroğlu, MD, Surgeon, Department of Neurosurgery, Haydarpaşa Sultan Abdülhamid Education and Research Hospital, Selimiye Neighborhood, Tibbiye Street, Istanbul 34000, Turkey. drahmeteroglu@gmail.com
Telephone: +90-506-2036231 Fax: +90-216-5422815
Received: April 8, 2018
Peer-review started: April 8, 2018
First decision: May 16, 2018
Revised: July 25, 2018
Accepted: August 11, 2018
Article in press: August 11, 2018
Published online: September 26, 2018
Processing time: 171 Days and 13.4 Hours
ARTICLE HIGHLIGHTS
Research background

The reasons for recurring carpal tunnel have been researched since the 1990s. Studies have investigated fibrosis and surgical techniques. This study, however, demonstrates that the median nerve should be relieved by full incision of the transverse ligament.

Research motivation

In carpal tunnel surgery, the recurrence rate was increased following the widespread use of the endoscopic and minimally-invasive techniques. A satisfying surgical outcome cannot be achieved if the compression caused by the transverse ligament cannot be completely relieved. The development of the endoscopic and minimally-invasive techniques and the proper training of relevant surgeons will decrease recurrence rates. The critical step in carpal tunnel syndrome surgery is the complete incision of the transverse ligament on the median nerve and the relief of the compression. Independent of the selected surgical technique, the complete incision of the transverse ligament should be ensured.

Research objectives

The main aim of the study is to perform carpal tunnel surgery with the appropriate surgical method without the need for a second operation. Re-operation on patients with recurrence prolongs the hospitalization time with consequential economic loss. Careful and appropriate surgery will prevent this. Appropriate surgical methods will also prevent surgeons from encountering medicolegal problems. Complete incision of the transverse ligament will reduce recurrence rates following carpal tunnel surgery.

Research methods

Four hundred and eighty-seven patients were evaluated retrospectively. The age, gender, physical evaluation findings, electrophysiological examination reports of the patients, and the implemented surgical treatment methods were recorded in this research.

Research results

Fibrosis and surgical methods have been criticized in the literature. However, this manuscript emphasizes the importance of removing ligament integrity completely. If the complete incision of the transverse ligament is not ensured with endoscopic and minimally-invasive methods, an open surgery technique must be implemented.

Research conclusions

Relief of the median nerve in carpal tunnel surgery occurs when the transverse ligament is completely incised. Recurrence rates therein decrease. Regardless of the surgical procedure, it should be ensured that the transverse ligament is completely incised. If minimally-invasive methods are insufficient in nerve decompression, open surgery should be performed.

Research perspectives

Complete incision of the transverse ligament will reduce recurrence rates following carpal tunnel surgery. This study demonstrates that the median nerve should be relieved by full incision of the transverse ligament. This manuscript emphasizes the importance of completely removing ligament integrity. A satisfying surgical outcome cannot be achieved if the compression caused by the transverse ligament cannot be completely relieved. The relief of the median nerve in carpal tunnel surgery occurs when the transverse ligament is completely incised. Recurrence rates therein decrease. If minimally-invasive methods are insufficient in nerve decompression, open surgery should be performed.