Many surgeons recommend their patients have a second carpal tunnel surgery after the first one failed. But it begs the (very legitimate) question, “What’s the chance my second surgery will fail too?”
It’s important for doctors to answer this question candidly. After all, why make patients suffer through another surgery when the second one might also fail?
Your first carpal tunnel release surgery has a statistical failure rate of 18-52%. This wide range depends on several factors. A primary factor is which medical journal reports the statistics.
The reporting of statistics heavily depends on how "surgical failure" is defined. Doctors and patients define failure differently.
1. Doctors were unable to completely cut the tissue (the transverse carpal ligament) they intended.
2. The surgery had to be terminated prematurely (usually due to respiratory or bleeding complications).
3. Symptoms never went away after the surgery.
1. By 2 years, carpal tunnel symptoms returned.
2. Complications (such as nerve damage, excessive bleeding, infection) were so great that the surgery wasn't worth the trouble.
3. Hand strength was permanently lost.
However you define "surgical failure", the outcomes of carpal tunnel surgery fall into one of several categories.
Often, a doctor will conclude you had a surgical failure if, for instance, your symptoms didn't resolve within 6 months. At that point, the doctor may recommend you have another surgery. This second carpal tunnel surgery is called "revision surgery".
Yes, that means having a second carpal tunnel surgery. That also means more pain, misery, expense, and loss of job time. Not to mention the extensive carpal tunnel recovery time and hand rehabilitation you'll need once again.
Many consciencious doctors began asking the obvious question, "If there is so much failure the first time, is there a way to predict the success of a second surgery?" Dr. John D. Beck (photo) studied this problem in detail.
In the journal American Society for Surgery of the Hand, Dr. Beck wrote a milestone article entitled Predicting the Outcome of Revision Carpal Tunnel Release. He studied patients over 2 years after they had a second carpal tunnel surgery. Some were successful the second time around. But some were failures once again.
For each patient, he looked back at their history within the previous 2 years. That helped him find correlations of past activities with the successes and failures he saw.
Dr. Beck focused on a patient's prior steroid shots. He analyzed if the second surgery’s success could be predicted by the results of the prior injections. In other words...
If steroid shots had a positive effect on temporary pain relief, would shots also predict if a second carpal tunnel surgery would be successful?
His findings were clear. Over 80% of the time, if a patient obtained good temporary relief with steroid shots, then he/she would have relief after the second carpal tunnel surgery. If they didn’t get good steroid shot relief, then a second surgery would probably fail.
Therefore, prior steroid shot results are a good predictor of the second surgery’s outcome.
Dr. Beck said steroid shot results are a “good screening test” to establish future success with revision carpal tunnel surgery.
The above discussion is startling in a very different way. Step back and ask yourself, “What’s wrong with this logic?”
Let's say you had 1 or 2 steroid shots. Each time they worked fairly well until their effects wore off. Then your doctor recommended carpal tunnel surgery.
You had the second surgery but it failed. Then the doctor said, “Since the shots relieved symptoms at first, I recommend another carpal tunnel surgery because THIS TIME there's an 80% chance of success.”
Why were you NOT informed from the beginning that you might need TWO surgeries to see success?
It’s evident that carpal tunnel surgery is pushed upon every patient, by nearly every hand surgeon in America. I personally have several hand surgeon friends who do nothing but carpal tunnel surgery. It's that lucrative.
So it’s no coincidence that carpal tunnel surgery is now the second most common surgical procedure. You can easily call it a surgical epidemic.
As a result, general practitioners are now sounding the alarms. They recognize that many good, non-surgical carpal tunnel treatments are available right now. This is why many doctors are opting to recommend such treatments even before thinking about a first surgery - let alone a second carpal tunnel surgery.
Remedies like simple rest, night bracing, hand and finger stretching exercises, and myofascial release massage are all effective for relieving carpal tunnel syndrome. And they don't require surgery.
For this reason, the American Academy of Orthopedic Surgeons (AAOS) published Clinical Guidelines on the Treatment of Carpal Tunnel Syndrome. In this doctor's guideline, the AAOS advises doctors to recommend all such non-surgical treatments first, before even thinking about surgery.
Also, they recommend using non-surgical remedies even if the first surgery fails to resolve the symptoms within 7 weeks.
Are you considering having a second carpal tunnel surgery because your first one failed? You can predict the success of your surgical outcome by how any prior steroid shots performed. But does it really make sense to have another surgery if you didn't try all non-surgical options first?
