Complications - Carpal tunnel syndrome – open carpal roof division

• Lesion/Transection of the median nerve, especially the thenar branch (Note: anatomical variations)
• Lesion of the superficial palmar arch at the distal wound pole
• Lesion of the ulnar artery and nerve during the division of the palmar carpal ligament
• Lesion of the palmar branch of the median nerve with too radial or proximal incision
• Incomplete division of the flexor retinaculum (digital control)

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 in the 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 condition

Late Complications

• Persistent symptoms of carpal tunnel syndrome
• Neuropathic pain
• Neurodesis pain
• Prolonged scar pain/neuroma pain
• Movement restriction
• CRPS (Sudeck's disease)

Management

• In neurologically confirmed (comparison with preoperative findings, exclusion of radicular cause) persistent carpal tunnel syndrome, repeat open carpal roof division
• In case of scar pain/neuroma pain/neuropathic pain, adopt a wait-and-see approach, consider revision if there is a proven lesion of the median nerve (nerve reconstruction), neuroma of the superior branch of the median nerve, or if symptoms persist for more than 6 months
• In case of irreparable damage to the thenar branch of the median nerve, possibly motor substitution plastic surgery
• In case of neurodesis pain with adhesions, various surgical techniques such as hypothenar fat flap plastic surgery
• For CRPS, appropriate treatment of the disease (see literature)