Management of Recalcitrant Carpal Tunnel Syndrome

被引:25
作者
Lauder, Alexander [1 ]
Mithani, Suhail [1 ,2 ]
Leversedge, Fraser J. [1 ,2 ]
机构
[1] Duke Univ, Med Ctr, Dept Orthopaed Surg, Durham, NC 27706 USA
[2] Duke Univ, Med Ctr, Dept Surg, Div Plast Surg, Durham, NC 27706 USA
关键词
PALMAR CUTANEOUS BRANCH; DOUBLE CRUSH SYNDROME; FAT PAD FLAP; MEDIAN NERVE; REVISION SURGERY; UPPER EXTREMITY; RECURRENT; PERSISTENT; RELEASE; PATHOPHYSIOLOGY;
D O I
10.5435/JAAOS-D-18-00004
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Recalcitrant carpal tunnel syndrome presents a clinical challenge. Potential etiologies of persistent or recurrent symptoms after primary carpal tunnel release include incomplete nerve decompression, secondary sites of nerve compression, unrecognized anatomic variations, irreversible nerve pathology associated with chronic compression neuropathy, perineural adhesions, conditions associated with secondary nerve compression, iatrogenic nerve injury, or inaccurate preoperative diagnosis. Understanding the pertinent surgical anatomy and pathophysiology is essential toward developing an effective diagnostic and treatment strategy. A thorough clinical history and examination guide a comprehensive diagnostic evaluation that includes serial examinations, neurophysiologic testing, and imaging studies. Conservative treatment may provide symptomatic relief; however, surgical management involving revision neuroplasty, neurolysis, nerve reconstruction, and/or local soft-tissue flap augmentation may be indicated in refractory cases.
引用
收藏
页码:551 / 562
页数:12
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