Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy.

This article has reviewed recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy of the median nerve. The problems surrounding the diagnosis and treatment of recurrent CTS have been discussed at length. The percent of failures from traditional open ligament surgery is observed to be high, and will become more prevalent as more casual treatments are carried out. This article makes a positive statement with reference to mobilization of the median nerve and anatomic restoration of the transverse carpal ligament. Fibrous fixation of the median nerve is a product of life and function. All cases are different, reflecting the strength, abilities, and personalities of the patients. A bottom line is drawn on these patients, where the summation of the problems of life become symptomatic and disabling. Epineural fibrous fixations induce median nerve traction, governed by hand, wrist, and forearm movements. Traction and tension suggest the intermittent disturbance of nerve nutrition and nerve conduction as the elastic limits of the nerve are approached. These factors accumulate and, in time, cause traction neuropathies with pain. This is followed by a reduced work capability. This impairment can be reversed by surgical nerve mobilization followed by functional nerve gliding therapy. A background history injury to the hand and wrist may be significant, as well as factors such as overuse and misuse of the hand and extremity. Prior to surgery, the careful application of diagnostic stress tests are essential, for the differential diagnosis of fixation traction and positional peripheral neuropathies. Nerve mobilization supported by magnification and the techniques of hand surgery has been successful by the methods discussed and has permitted, importantly, the restoration of the anatomic retinaculum for the flexor tendon system. This can be restored in carpal tunnel surgery and reconstructed with basic ligament material in recurrent carpal tunnel surgery.