Recurrent Carpal Tunnel

Overview

Recurrent Carpal Tunnel Syndrome (All cases have been referred by outside surgeons)

Recurrent carpal tunnel syndrome occurs in patients that have undergone open or endoscopic carpal tunnel release and then represented with numbness tingling and paresthesias in the thumb through radial half of the ring finger.  In general, it is related to scarring over the median nerve and sometimes related to an incomplete carpal tunnel release.  This is why it is important to perform carpal tunnel surgery the first time only when necessary.

Dr. Anup Patel Advantage

Dr. Anup Patel performs decompression of nerve compressions including some of the rarest syndromes encountered in the upper extremity. Trained by Dr. David T.W. Chiu, a pioneer and leader in microsurgery and nerve disorders, and Dr. John Persing, a pioneer and leader in neurosurgery, Dr. Patel often employs microsurgical techniques with precise dissection to relieve pressure on the nerves.

Dr. Chiu and Dr. Patel were recognized on the Tonight Show for their work in treating the peripheral nerve compression of Jimmy Fallon. Dr. Patel routinely treats patients from around the world suffering from nerve issues causing pain, sensory disturbances, and motor function loss.

Even with perfect releases, recurrent carpal tunnel can occur secondary to the median nerve developing significant scarring around it.  This is an extremely challenging’s problem to address.  It requires an experience microsurgeon as the operation employs microsurgical techniques to release the nerve from all of the scar surrounding it.

Following this, the surgeon must be well-versed to utilized muscle flaps or synthetic nerve wraps to provide the nerve a barrier from future scarring. Dr. Patel does the surgery using a microscope to ensure unparalleled visualization of the median nerve and its fascicles.

Symptoms

  • The same symptoms of carpal tunnel that occur after surgery for carpal tunnel at least 6 months before
  • Numbness, tingling, weakness, paresthesias and pain radiates from the wrist to the tips of the thumb through ring fingers
  • These symptoms may become worse at night (e.g., nocturnal numbness)


Causes

  • Compression of the median nerve from the following: failure to adequately release the carpal tunnel in the primary operation, scarring of the median nerve, and possible injury to the median nerve


Treatment: Non-Surgical

  • Wrist brace
  • NSAIDs
  • Steroidal injection into the carpal tunnel


Treatment: Surgical

  • Ensuring carpal tunnel is fully released
  • Use of microscope to perform internal neurolysis of the median nerve removing any scarring of the median nerve
  • Placing a barrier of the median nerve and surrounding structures that can release to a synthetic nerve wrap, muscle flap, or combination of the two generally using a microscope

Patient 1

67 year old female school teacher who underwent right open carpal tunnel release 15 years ago with an outside surgeon presents with nocturnal numbness, tingling and paresthesias in the right thumb to radial half of the ring finger that wakes her up at night. She has failed steroidal injection and bracing. She has electrodiagnostic studies showing moderate to severe carpal tunnel syndrome.

The patient undergoes extended open carpal tunnel release, internal neurolysis of the median nerve using a microscope, and nerve wrap. She has improvement of her symptoms enabling her to sleep.

Patient 2

62 year old retired female who underwent right open carpal tunnel release 12 years ago with an outside surgeon presents with nocturnal numbness, tingling and paresthesias in the right thumb to radial half of the ring finger that wakes her up at night. She has failed steroidal injection and bracing. She has electrodiagnostic studies showing moderate to severe carpal tunnel syndrome.

The patient undergoes extended open carpal tunnel release, internal neurolysis of the median nerve using a microscope, and nerve wrap. She has significant alleviation of her symptoms enabling her to sleep.

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Dr. Anup Patel

Dr. Anup Patel is a board-certified plastic and reconstructive surgeon trained in aesthetic, hand/upper extremity and reconstructive surgery. He completed his plastic and reconstructive surgery training at the premier Yale University followed by a hand and microsurgery fellowship at the New York University Institute of Reconstructive Plastic Surgery and Mount Sinai Department of Orthopedics. Dr. Patel received his MD and MBA from the Yale University School of Medicine and Yale University School of Management, respectively. He graduated as the valedictorian of his class at the University of Florida majoring in economics, biochemistry and molecular genetics and valedictorian of his high-school class at Lake Highland.

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