Traitement des complications de la chirurgie du canal carpien

Abstract: Treatment of the post-surgical complications of carpal tunnel syndrome. Carpal tunnel surgery is the most frequently performed operative procedure in hand surgery centers. Surgical teatment for complications is more and more frequent. Among these complications we distiguish : complications after a lésion of a major anatomical stucture, complications secondary to flexor retinaculum section, incomplet release or recurrent syndrome, at least non specific complications. Nerve, vessel and tendon injuries must be treated without delay. Deffered surgery is more difficult and results are worse. In some cases of median nerve laceration an opponensplasty can be performed to improve hand fonction. Pillar pain is a frequent post-operative complication, about 30% of the cases. The cause of pillar pain remains elusive : alterations of the carpal arch, ligaments, muscles or nerves. Some complications can be considered as secondary effect of flexor retinaculum section : strenght’s decrease, trigger fingers, flexor tendons luxation and ulnar nerve compression at the Guyon tunnel. Persistence or recurrence of the clinical signs of carpal tunnel syndrome are the most frequent causes of surgical reexploration. Incomplete release of the flexor retinaculum and median nerve “neurodesis” are respectively in cause. The diagnostic must be confirmed, the surgical procedure consits in a complete retinacular section, neurolysis and in the majority of the cases an interposition vascularised flap. [Copyright &y& Elsevier]