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Reoperative Options for Compressive Neuropathies of the Upper Extremity

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Reoperative Hand Surgery

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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.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of California, Irvine, Orange, CA, USA

    Jason R. Kang BS

  2. Department of Orthopedic Surgery, University of California, Irvine, 101 The City Drive South Pavillion III, Building 29A, Orange, CA, 92868, USA

    Ranjan Gupta MD

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  1. Jason R. Kang BS
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Correspondence to Ranjan Gupta MD .

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  1. , Chairman, Department of Orthopedic, Ochsner Health System, New Orleans, 70121, Louisiana, USA

    Scott F.M. Duncan

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Kang, J.R., Gupta, R. (2012). Reoperative Options for Compressive Neuropathies of the Upper Extremity. In: Duncan, S. (eds) Reoperative Hand Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2373-7_14

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