Elsevier

Hand Clinics

Volume 31, Issue 2, May 2015, Pages 139-149
Hand Clinics

Complications of Compressive Neuropathy: Prevention and Management Strategies

https://doi.org/10.1016/j.hcl.2015.01.012Get rights and content

Section snippets

Key points

  • Prevention of complications begins with a solid understanding of the normal anatomy and anatomic variations that may exist.

  • Carpal tunnel release is among the most common hand surgical procedures performed, but complications occur in up to 25% of cases. Revision carpal tunnel surgery may be indicated in patients who present with recurrent, persistent, or new symptoms due to inadequate release, iatrogenic injury, recurrent symptoms, or perineural fibrosis.

  • Cubital tunnel syndrome is the second

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy, affecting 1.6% to 7.8% individuals.4, 5, 6 Carpal tunnel release (CTR) is one of the most frequently performed outpatient procedures in the United States, and is typically considered to be a minor elective and routine procedure.7 Complications are rare, but can result in devastating loss of hand function.

Cubital tunnel syndrome

Cubital tunnel syndrome (CuTS), or compression of the ulnar nerve at the elbow, is the second most common compression neuropathy, and up to 75,000 decompression releases are performed in the United States yearly (Fig. 2).68, 69 Although multiple strategies are described, no single technique has emerged as superior, and in situ decompression and anterior transposition are most commonly performed.69, 70 Nerve transpositions may be performed subcutaneously, intramuscularly (within the

Summary

Surgery for upper extremity compressive neuropathies is relatively common. To prevent iatrogenic injury, it is imperative for the surgeon to be aware of the structures associated with normal surgical anatomy and of those that are common variants. In addition, recurrent or persistent symptoms following a release are commonly associated with inadequate release, but can be associated with misdiagnosis. For either of these etiologies for failed decompression, it is crucial to perform a thorough

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    Disclosures: None.

    Supported in part by a Midcareer Investigator Award in Patient-Oriented Research (K24 AR053120) to Dr K.C. Chung.

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