Revision carpal tunnel release and coverage using a hypothenar fat pad flap

Incomplete release of the transverse carpal ligament or secondary site of median nerve compression is the most common indication, accounting for around 43% of patients who undergo revision CTR.

Incomplete release is associated with an acute worsening of carpal tunnel symptoms secondary to a more concentrated area of compression.

Persistent symptoms can be secondary to a diagnosis of diabetic neuropathy, cervical radiculopathy, or more proximal compression (Pronator syndrome).

Recurrent carpal tunnel syndrome is diagnosed if symptoms reappear after at least 6 months of temporary relief after primary CTR.

Recurrent symptoms can be secondary to perineural adhesions or reconstitution of the transverse carpal ligament, which leads to fibrosis around the median nerve.

New symptoms immediately after surgery can result from iatrogenic nerve injury. This includes partial or complete transection of the median nerve, recurrent motor branch, or palmar cutaneous branch of the median nerve.