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Reoperative Options for Compressive Neuropathies of the Upper Extremity

  • Jason R. Kang
  • Ranjan GuptaEmail author
Chapter

Abstract

In addressing failed surgery for compressive neuropathies about the arm, it is important to distinguish between what would truly be called recurrence vs. those who have a failure to improve in their symptoms. Evaluation of these patients does require some time in both obtaining a thorough history as well as performing a detailed clinical exam. Electromyographic and neural conduction velocity testing is helpful. In these cases, the surgeon needs to think both proximal and distal; that is, could the symptoms be coming from the neck or could there be areas of further compression proximally or distally about the peripheral nerve? Reoperating on previously operated nerve tissue can be quite stressful as the nerve tissue is frequently less forgiving than other soft tissue structures commonly encountered in the scar bed. The use of a microscope can sometimes be helpful in visualizing the tissue planes and/or nerve tissue. If mechanical reasons are found to explain the patient’s continued symptoms, then these points of compression can be surgically addressed if the patient is willing to accept the potential risks of nerve injury and further scarring, which sometimes precludes the patient from improving as much as both doctor and patient were hoping.

Keywords

Carpal Cubital Radial Tunnel Syndrome Recurrence 

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryUniversity of California, IrvineOrangeUSA
  2. 2.Department of Orthopedic SurgeryUniversity of California, IrvineOrangeUSA

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