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Op. Dr. Tolga Mertoğlu

RECURRENT CARPAL TUNNEL SYNDROME

Diagnosis of Recurrent Carpal Tunnel Syndrome

Tekrarlayan Karpal Tünel Sendromu

The complaints of numbness, loss of sensation and pain, especially at night, observed in the first round of the disease recur. In severe cases, a decrease in the grasping strength and atrophy of hand muscles may be observed. EMG used for nerve conduction measurement is not as valuable as in the diagnosis of primary nerve compression. Because even with a proper treatment, EMG findings return to normal in only 6 months. MRI and Ultrasound are used to examine the presence of a mass in the canal and the continuity of the nerve. Despite all these methods of examination, the most important diagnosis method is the patient to describe the electrification when the nerve is hit with the tip of the finger.

Complications that may occur in carpal tunnel surgery;  injury of the median nerve during surgery, the formation of painful swellings called neuroma at the ends of the injured nerve, wound problems and insufficient tunnel loosening. The most common cause of secondary carpal tunnel laxity surgeries is insufficient loosening. Other reasons for the recurrence of the disease are inflammation of the tendons covering the fingers at the wrist level, the pressure of the scar tissue on the nerve, the formation of a mass in the carpal tunnel and post-operative stretching of the nerve. Presence of diabetes, hypertension and rheumatic diseases are risk factors for recurrence of the disease.

 

Treatment of Recurrent Carpal Tunnel Syndrome

Treatment is surgical. The previous surgery area is opened wider and the possible damage to the nerve, the presence of painful nerve ending thickening called neuroma, and whether the canal is completely opened and loosened is examined. If there is an incision in the nerve, repair is performed by using microsurgical methods. Neuromas are cleaned. If the nerve is cut and the ends cannot be joined, repair is performed by placing the nerve obtained from the leg as a bridge in between. In order to provide a slippery and moist environment to the median nerve, which is subjected to repeated surgical intervention, a vascular adipose tissue spiral is made from the surrounding adjacent tissues. Cast is applied to the wrist for 2-4 weeks postoperatively. Healing findings can be observed immediately in some patients, whereas it may take up to 6 months in others.

 

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