I’m trying to make a difficult decision about my carpal tunnel syndrome. I’ve had it for six years even after surgery five years ago. Obviously, it hasn’t gone away on its own or with any of my efforts. Would another surgery be worth it? Would it work if it didn’t work the first time?

You are not alone in facing this dilemma. One out of every five patients who has a carpal tunnel release reports that symptoms of pain, weakness, numbness, and/or tingling are still present years later. A second operation might be helpful.

In fact, about five per cent of the patients who are left with residual symptoms do end up having a second or revision surgery. And studies show that the second surgery is not always successful — statistics show the revision carpal tunnel release is less likely to help if the first surgery was not a success.

So the question comes up: is there some test or some way to predict who might benefit from a second surgery? Surgeons are studying this problem with a few good results. For example, some studies have been done to show that steroid injection into the carpal tunnel before the primary (first) surgery is a good predictor of symptom improvement after surgery. Could this same approach be used after a failed first surgery before considering a second (revision) release?

Surgeons conducted another study to check this idea out. They injected the wrists of 23 patients (for a total of 28 wrists because a couple of people had carpal tunnel in both wrists). The patients involved ranged in ages from 29 to 85 years.

Some of the patients had symptoms 40 years after the first surgery. Everyone was carefully evaluated before injection. The surgeons wanted to make sure the persistent symptoms were really coming from pressure on the median nerve as it passed through the wrist bones forming the carpal tunnel.

A single injection of cortisone into the carpal tunnel space was given to each patient. Results were recorded based on whether or not the symptoms were relieved or eliminated. Then the second carpal tunnel release was performed. Patients were followed for six months after the second surgery. They were re-evaluated at regular intervals during that time.

Measures of success included symptom improvement and patient satisfaction. A positive report of patient satisfaction was defined as being willing to have the second surgery again if they had to do it all over again. Patients who had enough symptom relief were more likely to say the gains received by a second surgery were enough to be satisfied that a second surgery was worth it.

In this group of 23 patients (28 wrists), 23 wrists had complete pain and symptom relief. Five patients were unchanged after the revision surgery. Three of the patients who did not have any change in symptoms DID have symptom relief (or improvement) with the steroid injection.

After analyzing all the data, the researchers concluded that the steroid injection by itself wasn’t statistically significant enough to predict surgical success. The surgeon’s evaluation of the patient (history and clinical observations/tests) alone was not able to predict the results either. But when combined together (results of injection with the results of the surgeon’s evaluation), they concluded that this approach could serve as a good screening tool.

With this information in the back of your mind, it might be a good time to make an appointment with an orthopedic surgeon or hand surgeon for a new evaluation. Once the surgeon completes his or her exam, you may have a better idea of what’s next. If revision surgery is recommended, consider asking about this technique of screening using a pre-operative steroid injection.