Vein Wrapping of the Median Nerve

Abstract

Carpal tunnel syndrome is the most common entrapment neuropathy of the upper extremity with an incidence of 99 per 100,000 [1].Surgical decompression by releasing the flexor retinaculum is the established treatment for this syndrome.Although surgical decompression is generally considered effective,recurrence of symptoms is not uncommon.Rates of treatment failures or recurrence have been reported to be as high as 32%[2–9].There are several reasons for persisting or recurrent pain following surgical decompression;incomplete release,injury to the nerve trunk or its branches resulting in neuromas,reflex sympathetic dystrophy,and scarring of an intact nerve.Incomplete release can be addressed with repeated decompression; neuromas are rare and are usually treated with neurolysis,resection,and possibly grafting,and for reflex sympathetic dystrophy treatment must be individualized.Scarring of the nerve is by far the most difficult condition to treat since attempts at repeated decompression and internal neurolysis further enhance scar tissue formation and recurrence is inevitable [10].