Failed endoscopic carpal tunnel release - Operative findings and results of open revision surgery

From 1994 to 1997, 22 patients (24 wrists) underwent open revision carpal t unnel release for persistent carpal tunnel syndrome after a primary endosco pic release. The age range was from 21 to 77 years. At the time of revision surgery, 22 wrists had an incomplete release of the flexor retinaculum and two patients had median nerve transection (one partial and one complete), One patient had release of Guyon's canal and not the carpal tunnel. After t he open revision carpal tunnel release, 20 patients returned to work with f ive patients returning to jobs of lighter duty In addition, these 20 patien ts had significant improvement in symptoms. The remaining two patients had sustained a median nerve injury and did not return to work. One of these pa tients developed a painful neuroma in continuity of the median nerve which required vein wrapping with a saphenous vein graft. This study indicates th at endoscopic release of the flexor retinaculum holds the same risks and co mplications as open release, Based on our study we believe that patients wi th persistent carpal tunnel syndrome after failed endoscopic flexor retinac ulum release can be successfully treated with open release.