Carpal and cubital tunnel release operations have a great success rate and usually bring about resolution of symptoms in most of the patients. In a small minority of the patients, however, there is persistent pain after the surgery or recurrence of the symptoms after the initial relief. This is a challenging situation to deal with, as there is a multitude of possible causes to be identified and addressed. Many patients will need further tests and investigations, and possibly further treatment.

The best way to discuss the possible reasons for persistence or recurrence of the symptoms is to divide them based on the effect that the initial surgery had. The information below is not meant to serve to self-diagnose but to demonstrate the complexity of the problem.

There may be more pain and worsening of the symptoms when comparing with the time before the surgery. Additionally, there may be a new onset of numbness and muscle weakness in the hand, and in case of the cubital tunnel syndrome, in the forearm as well.

Possible explanations for this are:

• nerve damage during the procedure, which may be complete or partial
• incomplete release of the compressed nerve where a swelling after the operation makes the compression problem worse
• collection of blood or tissue fluid in the wound

These are likely to need further surgery.

The possible explanations are:

1) Incomplete release of the compressed nerve during the surgery

2) Incomplete initial diagnosis

• occasionally it happens that the nerve treated has an additional site of compression to the one where the surgery was carried out. In this case the initial surgery may not have had any benefit or might provided only a partial resolution of the symptoms. For both the median nerve (carpal tunnel) and the ulnar nerve (cubital tunnel) there are other sites where the nerves can get compressed on their way from the spinal cord in the neck, all the way down to the hand
• there may be additional factors compressing the nerve – tumours, abnormal anatomical structures, abnormal tissues (such as in rheumatoid arthritis or amyloidosis patients)

3) Incorrect initial diagnosis

• A rare situation where there is another condition affecting the function of the nerves that is mimicking signs of carpal or cubital tunnel syndrome.

All of the above situations are likely to need further investigations and possibly further treatment.

This is called the recurrent carpal or cubital tunnel syndrome and is likely to be due to reforming of the structures which were released or due to encasing of the released nerve by scarring.

The situation will require further investigations in the first instance. Depending on the case, a conservative approach with targeted physiotherapy or further surgical treatment may be needed here.