If carpal tunnel surgery didn’t work the first time, is there any point in doing it again?

Symptoms after carpal tunnel surgery must be evaluated carefully to determine whether this is a case of persisting symptoms (they never went away with the surgery), recurrent symptoms (the symptoms went away but came back later), or new symptoms (a different problem). Treatment will be planned according to the findings.

For example, there could be scar tissue that has built up around the median nerve and nearby soft tissues contributing to the problem. A short course of conservative (nonoperative) care might help restore the natural sliding and gliding of the nerve necessary for normal function. But sometimes only surgery to release these compressive tissues will restore full blood supply to the area and thereby alleviate the painful symptoms.

A recent study by researchers from the Division of Plastic and Reconstructive Surgery (Washington University in St. Louis School of Medicine) may have some information to help you in making your decision about revision surgery.

They took a look back at patients (all adults) who had a first carpal tunnel surgery before 2001. Each one was evaluated and placed in one of three groups. The groups included patients who had carpal tunnel symptoms that continued after the first surgery (group one), recurrent (group two: symptoms went away after surgery but then came back), or group three: new symptoms developed.

Medical records for each patient were reviewed and analyzed looking at a variety of information and factors. For example, they paid attention to the surgeon’s notes during the revision procedure. Two areas of interest from the notes were: 1) how the revision procedure was done and 2) what the surgeon found at the time of the surgery.

Information about the patients (e.g., age, work status, use of pain medications, results of electrodiagnostic tests) was collected and compared among the three groups. Clinical measures of grip and pinch strength were also measured, reported, and compared. Pain level and quality of life were also assessed. The authors provided all of this information for each group in a table for anyone interested in the exact details.

When trying to find some differences among the three groups, the only significant factors were diabetes and longer time between first and second surgeries. These two variables were specific to the group with recurrent symptoms. New symptoms occurred more often in people who had an unintended nerve injury during the first surgery.

Clinically, everyone in all three groups did get pain relief with the revision surgery. Grip and pinch strength improved for the persistent and new group (as symptoms resolved) but not for the recurrent group. Overall, the long-term results were positive for all groups. This is good news for patients like you who are facing the possibility of a second surgery for carpal tunnel syndrome when the first procedure was less than successful.