![]() Provocative maneuvers, such as Phalen’s and Durkan’s tests and Tinel’s sign, are useful in eliciting compression in the carpal tunnel, especially when compared to the contralateral side and to preoperative assessments. These studies are particularly valuable when preoperative studies are available for comparison. Ĭlinical examination maneuvers, diagnostic studies, and diagnostic injections are all options in evaluating a patient with recurrent carpal tunnel syndrome. The only difference is a slightly higher risk of catastrophic complications with endoscopic release, most commonly from complete transection of the median nerve. However, meta-analysis data on endoscopic versus open releases find that endoscopic release is comparable to open release in regard to most complications, including the need for revision surgery and rate of persistent symptoms. Endoscopic carpal tunnel release has often been cited as a risk factor for incomplete release of the transverse carpal ligament, particularly in early studies of endoscopic release. Compression occurred at the distal transverse carpal ligament in 56% of cases and at the proximal antebrachial fascia at the wrist crease in 44% of cases. A recent study analyzing 50 patients who required revision carpal tunnel release found that 58% of patients had persistent symptoms due to incomplete release. Persistent symptoms are most commonly caused by incomplete release of the transverse carpal ligament. ![]()
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