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Self-reported Outcomes for Patients Undergoing Revision Carpal Tunnel Surgery with or without Hypothenar Fat Pad Transposition
Gregory I. Pace, MD; David Gendelberg, MD; Connor Zale, BS; Kenneth F. Taylor, MD
Pennsylvania State University College of Medicine, Hershey, PA
Purpose: Carpal tunnel release for the treatment of carpal tunnel syndrome is the most common surgical procedure performed on the hand. While complications are rare, recurrent or persistent carpal tunnel syndrome can be a significant problem after primary decompression. Various procedures have been described for the treatment of these patients with the most common including repeat decompression and hypothenar fat pad transposition. The purpose of this study is to compare the long-term outcomes of patients undergoing revision carpal tunnel surgery with repeat decompression with and without hypothenar fat pad transposition.
Methods: We performed a retrospective review of all patients undergoing revision carpal tunnel surgery at our institution between 2002 and 2014. Identified subjects were contacted by telephone. A Boston Carpal Tunnel Questionnaire (BCTQ) was administered to all subjects.
Results: Seventy-six patients underwent revision carpal tunnel surgery over the study period. Twenty-nine of 45 potential subjects provided a survey response (64.9%) representing a total of 33 carpal tunnel revision surgeries. Seventeen hands underwent repeat decompression alone and 16 hands underwent repeat decompression with hypothenar fat pad transposition. A trend towards improved overall BCTQ score was noted for patients undergoing decompression alone, however no significant difference was determined for total survey score by procedure type. Similarly, total symptom severity and functional scores were not statistically significant between groups, however a trend towards significance for improved symptom severity score was observed in patients undergoing decompression alone.
Conclusion: Repeat decompression and hypothenar fat pad transposition are two of the most common procedures performed for revision carpal tunnel surgery in patients with persistent or recurrent symptoms following primary decompression. Our data does not support the routine use of hypothenar fat pad transposition for revision carpal tunnel surgery in patients with persistent or recurrent symptoms following primary decompression. The significance of intraoperative findings including median nerve scarring and apparent incomplete release are yet to be elucidated, however excellent results have been reported in our study and prior studies with both procedures. While we cannot go as far as to make a recommendation for or against the use of the hypothenar fat pad transposition based on the results of our study, we call into question the necessity of commonly performed supplementary procedures for the treatment of recurrent or persistent carpal tunnel syndrome.
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