Complications - Carpal Tunnel Syndrome – Open Carpal Tunnel Release

• Lesion/Severance median nerve, especially thenar branch (Caution: anatomical variants)
• Lesion of the superficial palmar arch at the distal wound pole
• Lesion of ulnar artery and nerve during splitting of the palmar carpal ligament
• Lesion of palmar branch of median nerve due to incision too far radial or proximal
• incomplete division of flexor retinaculum (digital check)

Management

• primary microsurgical nerve or artery suture in case of nerve or artery injury
• Careful division of the flexor retinaculum and palmar carpal ligament

Acute Complications

• Bleeding/Hematoma Carpal Tunnel
• Infection/Wound Healing Disorder

Management

• in case of recurrent/persistent carpal tunnel syndrome due to bleeding, surgical revision
• in case of infection, immediate surgical revision
• in case of wound healing disorder, surgical revision depending on the severity of the findings

Late Complications

• persistent symptoms of a carpal tunnel syndrome
• neuropathic pains
• Neurodesis pains
• protracted scar pains/neuroma pains
• Restriction of Movement
• CRPS (Sudeck's Disease)

Management

• in case of neurologically confirmed (comparison of preoperative findings, exclusion of radicular cause) persistent carpal tunnel syndrome, renewed open carpal roof division
• in case of scar pains/neuroma pains/neuropathic pain, watchful waiting, consider revision in case of proven lesion of the median nerve (nerve reconstruction), neuroma of the superficial branch of the median nerve or in case of complaints persisting for over 6 months
• in case of irreparable damage to the thenar branch of the median nerve, possibly motor replacement plasty
• in case of neurodesis pains with adhesions, various surgical techniques with e.g. hypothenar fat flap plasty,
• For CRPS, appropriate therapy of the disease (see specialist literature)