The incidence and decompression rates of median and ulnar neuropathies following shoulder surgery.

Background: Upper extremity peripheral neuropathy is a known, but uncommon complication that can occur after shoulder surgery. The incidence rate is well documented, and most of these cases historically have been treated conservatively. However, we hypothesize peripheral compression neuropathy requires a much higher need for surgical decompression than originally reported. The purpose of this study was to evaluate the incidence, decompression rates, and prognostic factors for developing median and ulnar neuropathies following shoulder surgery. Methods: A retrospective chart review was performed examining patients who underwent open and arthroscopic shoulder surgery from a multisurgeon, single-institution database. Perioperative data and functional outcomes were recorded. Symptom resolution was assessed with both conservative and surgical management of compression peripheral neuropathy. Further analysis was made to compare open and arthroscopic procedures, the type of neuropathy developed, and electromyographic (EMG) severity. Results: The incidence rates of compression peripheral neuropathy following open arthroplasty and arthroscopic procedures was 1.80% (31/1722) and 0.54% (44/8150), respectively. 73.33% (55/75) of patients developed ipsilateral disease, while 20.00% (15/75) of patients had bilateral disease. Amongst the 75 included patients, there were 99 cases of neuropathy. Carpal tunnel syndrome was more common than cubital tunnel syndrome, comprising 61.61% (61/99) cases of neuropathy. 12.00% (9/75) of patients developed both carpal tunnel syndrome and cubital tunnel syndrome. Four patients were lost to follow-up. Decompression surgery was performed for 36.84% (35/95) cases of neuropathy with >90% obtaining symptom resolution with surgery. 63.16% (60/95) cases of neuropathy were managed conservatively, 71.67% (43/60) of which had persistent symptoms. When comparing arthroscopic versus open procedures, patients who underwent open procedures were significantly older (68.62 vs. 49.78 years, P < .001) and developed peripheral neuropathy significantly faster after the index procedure (87.24 vs. 125.58 days, P = .008). EMG severity did not correlate with decompression rates or symptom resolution. There were no differences in the subgroup analyses between beach chair and lateral positioning in regard to the type of neuropathy, laterality of symptoms, and/or treatment received. Conclusion: The overall incidence of peripheral neuropathy after shoulder surgery was 0.76% (75/9872). The development of peripheral neuropathy is multifactorial, with older patients undergoing open arthroplasty more at risk. Neuropathy symptoms were refractory to conservative management despite the type of shoulder surgery, type of neuropathy, or EMG severity. Decompression consistently led to resolution of symptoms.

Articular Fragment Escape and Carpal Subluxation Following Distal Radius Fracture Fixation.

Surgical fixation of distal radius fractures is among the more common procedures performed by hand surgeons. The approach to surgical management is based on a variety of factors including injury mechanism, fracture pattern, patient characteristics, bone quality, soft tissue injury, and surgeon preference. For the majority of fracture types, volar locking plate fixation has become the most commonly used method of fracture fixation. Although uncommon, complications can arise following this form of treatment, one of which is escape of an articular fragment with resultant carpal instability. More often seen in conjunction with poorly reduced or captured displaced volar lunate facet fragments, fixation failure and carpal instability can occur with other fracture patterns that have garnered less attention, particularly those involving the radial column or dorsal lunate facet. Thorough preoperative planning to recognize fracture patterns that lead to this complication is paramount. Proper selection of implants used to secure the fracture and the choice as well as duration of postoperative immobilization is critical to minimizing this complication. We aim to (1) describe the relevant anatomy involved with this complication, (2) organize and classify the various distal radius articular fragment escape patterns that can occur following fracture fixation, and (3) discuss strategies that can help prevent this complication.

Direct Variable Cost Comparison of Monitored Anesthesia Care Versus Wide Awake Local Anesthesia No Tournique Carpal Tunnel Release: A Time-Driven Activity-Based Costing Analysis.

PURPOSE: Time-driven activity-based costing (TDABC) provides a more accurate and granular estimation of direct variable costs compared with traditional accounting methods. This study used TDABC to quantitatively compare the same-day facility costs of open carpal tunnel release (CTR) performed under monitored anesthesia care (MAC) versus wide awake local anesthesia no tourniquet (WALANT). METHODS: We retrospectively identified 474 unilateral CTR (182 MAC and 292 WALANT) performed at an orthopedic specialty hospital between 2015 and 2021. Itemized facility costs were calculated using a TDABC algorithm. Patient demographics, surgical characteristics, and itemized costs were compared between those treated under MAC (MAC-CTR) and WALANT (WALANT-CTR). Multivariable regression was performed to determine the independent effect of MAC on true facility costs. RESULTS: Total facility costs were $170 higher in MAC-CTR compared with WALANT-CTR ($652 vs $482). Monitored anesthesia care-CTR cases had higher personnel costs ($537 vs $394), likely because of higher surgery personnel ($303 vs $185) and postanesthesia care unit personnel costs ($117 vs $95). Monitored anesthesia care-CTR cases also had higher supply costs ($119 vs $81). When controlling for demographics and comorbidities, MAC-CTR was independently associated with an increase in personnel costs by $150.65 (95% CI, $131.09-$170.21), supply costs by $24.99 (95% CI, $9.40-$40.58), and total facility costs by $175.66 (95% CI, $150.18-$201.09) per case. CONCLUSIONS: Using TDABC, MAC-CTR was found to be 35% more costly to the facility compared with WALANT-CTR. Notably, WALANT-CTR facility costs presented here do not include additional cost savings from anesthesiologist service fees or preoperative laboratory clearance required for MAC-CTR surgeries. To reduce costs related to CTR surgery, greater efforts should be made to reduce the number of intraoperative personnel and maximize the use of WALANT-CTR in an outpatient setting. TYPE OF STUDY/LEVEL OF EVIDENCE: Economic and Decision Analysis II.

Assessment of the Carpal Tunnel Syndrome in Female Patients With Hypothyroidism.

Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. There are several factors that influence the severity of CTS. The purpose of this study was to explore the severity of CTS in hypothyroid patients. Methods: This cross-sectional study was conducted in the university clinic. Seventy-six participants with a clinically and electrophysiological confirmed diagnosis of CTS were included in the study. The demographic data and severity of CTS were analyzed based on the presence (n=38) or the absence (n=38) of primary hypothyroid disease. Thirty-eight hypothyroid patients who were being treated were included in this study. For the assessment of the severity of CTS, the Boston questionnaire (BCTQ) and electrodiagnostic tests were used. For data analysis, an independent sample t-test and chi-squared test were carried out. A P<0.05 was considered significant. Results: The mean age of hypothyroid and non-hypothyroid CTS patients was 46.21±7.22 and 44.24±8.02 years, respectively. Body mass index (BMI) was >30 kg/m2 in both groups. There was no significant difference in demographic data among the two groups. The mean score of symptom severity in hypothyroid and non-hypothyroid-CTS patients were 30.37±10.84 and 35.89±7.19, and also functional status was 21.71±9.04 and 25.92±6.62, respectively. There was a significant difference between the two groups, in terms of symptom severity scale (P=0.017, 95% CI, 31.14%, 35.48%) and functional status scale (P=0.023, 95% CI, 21.95%, 25.67%). In terms of electrophysiological findings, there was no statistically significant difference between these two groups. Conclusion: The results of this study indicated that, contrary to expectation, the severity of CTS is higher in non-hypothyroid patients than in hypothyroid patients.

Assessing the severity of carpal tunnel syndrome during physical examination by measuring two-point discrimination: Post-hoc analysis of prospectively collected data.

INTRODUCTION: Carpal tunnel syndrome (CTS) commonly presents after distal radius fractures. Assessing its degree of severity is essential to therapeutic decision-making - i.e. operative vs. conservative treatment. The role of the two-point discrimination (2PD) has not yet been evaluated as a potential indicator of severity during physical examination. Therefore, in our cross-sectional study, we aimed to find a correlation between 2PD values and disease severity, based on the gold-standard electromyography and electroneurography (EMG-ENG) and ultrasonography findings. METHODS: We conducted a post-hoc analysis of prospectively assessed CTS patients for 2PD values. We analyzed the correlation between 2PD and EMG-ENG measurement results, patient characteristics, nerve ultrasonography, and relevant CTS questionnaires. CTS severity was determined by EMG-ENG results. The Pearson correlation was calculated between variables. RESULTS: The study included 81 patients. The three pre-determined EMG-ENG severity categories showed a significant correlation between both 2PD values and 2PD severity categories (r= 0.29 [0.07-0.48] and r= 0.26 [0.03-0.45]). Distal sensory latency and conduction velocity values correlated significantly with 2PD categories. However, the correlation coefficients (r= 0.25 [0.02-0.46] and r=-0.24 [-0.37-0.07]) were low. The 2PD severity categories showed no significant correlation with the severity assessed by nerve ultrasound (r=-0.07 [-0.38-0.25]). The 2PD values showed a significant correlation between the values of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (r= 0.3 [0.06-0.51]). We concluded that the best cut-off value for differentiating severe from non-severe CTS was at the 9.5 mm 2PD cut-off value (sensitivity = 0.65 [0.45-0.81], specificity = 0.71[0.58-0.82], AUC = 0.71 [0.59-0.83]). CONCLUSION: There is a significant correlation between 2PD values and the severity of carpal tunnel syndrome as determined by EMG-ENG; however, they are not interchangeable. Based on the results of our study, we propose that measuring two-point discrimination may be a quick and easy, reliable and cost-effective screening method to assess the severity of carpal tunnel syndrome following distal radius fractures.

Percutaneous Ultrasound-Assisted Carpal Tunnel Release Using Sono-Instruments®.

Percutaneous ultrasound-assisted carpal tunnel (CT) release is an emerging minimally invasive technique in hand surgery that could reduce complications, enhance patient satisfaction, and facilitate earlier return to daily activities. Among the various devices employed for this procedure, the Sono-Instrument allows pin-hole surgery. Its safety and effectiveness have been established. This study presents the technical nuances, pearls and pitfalls, advantages, and challenges of using the Sono-Instrument for percutaneous ultrasound-assisted CT release.

Ultrasound-Based Grading of Carpal Tunnel Syndrome: A Comparative Study of Cross-Sectional Area and Shear Wave Elastography at Different Wrist Joint Angles.

OBJECTIVE: Carpal Tunnel Syndrome (CTS) is a prevalent neuropathy where accurate diagnosis is crucial for effective treatment planning. This study introduces a novel approach for CTS grading using ultrasound, specifically through the analysis of the cross-sectional area (CSA) and shear wave elastography (SWE) of the median nerve in various wrist positions. METHODS: Our research involved subjects from outpatient clinics, diagnosed with CTS through Nerve Conduction Studies (NCS), and a control group of healthy individuals. High-frequency ultrasound and SWE measurements were conducted in three wrist positions: straight, 45° extension, and 45° flexion. RESULTS: The key findings revealed significant differences in median nerve CSA and SWE values between the CTS and control groups across all wrist positions, with notable variances in SWE values correlating with wrist positioning. SWE demonstrated enhanced sensitivity and specificity in distinguishing between mild, moderate, and severe CTS, especially at 45° wrist flexion. In contrast, CSA measurements were limited in differentiating between the varying severity stages of CTS. CONCLUSIONS: The study concludes that SWE, particularly at 45° wrist flexion, provides a more precise diagnostic benchmark for CTS severity grading than CSA. This advancement in non-invasive diagnostic methodology not only aids in accurate CTS grading but also has significant implications in formulating tailored treatment strategies, potentially reducing the reliance on more invasive diagnostic methods like NCS. ADVANCEMENT IN KNOWLEDGE: This study marks a significant advancement in the ultrasound diagnosis of CTS. It particularly highlights the importance of applying SWE technology across various wrist joint angles, offering a new diagnostic benchmark. This discovery provides data support and additional insights for achieving an early consensus on ultrasound-based grading diagnosis of CTS.

Utility of Handheld Ultrasound in Identifying Millimeter-Sized Vasculature in Living and Cadaveric Subjects.

Objective This study aims to investigate the utility of handheld, Bluetooth-capable ultrasound in identifying millimeter-sized vasculature in both living and cadaveric subjects. Methods Using handheld, linear ultrasound probes, the carpal tunnel of 87 living individuals (174 forearms) was assessed for the presence of a persistent median artery (PMA). Radial, ulnar, and persistent median arterial diameters were measured, along with forearm circumference. Using the same probes, 46 cadaveric forearms were assessed for the presence of a "potential" PMA. Those same forearms were subsequently dissected to confirm the presence of the artery.  Results A PMA was identified in 3.4% of individuals (1.7% of forearms). Radial, ulnar, and persistent median arterial diameters were 2.12 ± 0.40 mm, 1.89 ± 0.41 mm, and 0.82 ± 0.33 mm, respectively. The radial artery was significantly larger than the ulnar artery (p < 0.0001). In cadaveric subjects, four "potential" PMAs were identified by pre-dissection ultrasound. Upon dissection, only one of the "potential" PMAs was confirmed, and three previously unidentified PMAs were identified.  Conclusions The prevalence of PMA in living subjects was lower than previously reported. Additionally, handheld ultrasound had low accuracy in identifying PMAs in cadavers prior to dissection. This could be an indication that current handheld ultrasound lacks the sensitivity to identify millimeter-sized vasculature, such as a PMA. In both populations of subjects, key, non-anomalous anatomy was readily seen, indicating the utility of handheld ultrasound in the proper context.

Dropping Objects in Carpal Tunnel Syndrome: Clinical and Electrophysiological Features.

Background Dysfunction in both afferent sensory and efferent motor components of the median nerve may contribute to the manifestation of the symptom of dropping objects (DO) in carpal tunnel syndrome (CTS). The objective of this study was to compare the clinical and electrophysiological characteristics of CTS patients with dropping objects (wDO) and those without dropping objects (w/oDO). The study evaluated the correlation between DO symptoms and median partial conduction block, as well as the reduction in median motor conduction velocity at the wrist. Methodology An examination for CTS and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) were performed. Median and ulnar sensory and motor nerve conduction studies were conducted in both upper extremities, and the percentage decrease in the median compound motor action potential amplitude at the wrist level was calculated. Results The study included 201 female participants aged between 22 and 88 years, comprising 57 patients with CTSwDO, 78 patients with CTSw/oDO, and 66 healthy controls. In the CTSwDO group, compared to the CTSw/oDO group, BCTQ scores were significantly higher, the prevalence of sensory deficits was more pronounced, and a larger number of hands, both dominant and non-dominant, were classified as stage 3 or higher in the clinical CTS classification. However, no correlation was found between the presence of DO symptoms and any neurophysiological findings. Conclusions DO may be a symptom of clinical severity in CTS, as previously reported. No neurophysiological parameter that could be associated with DO was identified.

Long-Term Functional Outcomes and Quality of Life Following Carpal Tunnel Release Surgery.

This study investigates the long-term efficacy of carpal tunnel release surgery (CTR) on patient outcomes. We aimed to assess symptom severity, functional limitations, and quality of life in a large cohort (n = 186) at least five years post-surgery via a retrospective cross-sectional design that evaluated participants using the validated Boston Carpal Tunnel Questionnaire (BCTQ) over a phone interview. The BCTQ measures symptom severity, functional limitations, and quality of life specific to carpal tunnel syndrome. Seventy-three percent (73.1%) of patients reported complete resolution of symptoms and functional limitations (BCTQ = 1) with an average follow-up of 11 years. No statistically significant decline in BCTQ scores was observed over time. Univariate analysis revealed a significant association between poorer outcomes and older age at surgery and current unemployment. Carpal tunnel release surgery demonstrates long-term effectiveness in relieving symptoms and improving function in most patients. These findings contribute to the understanding of CTR's impact on patient well-being beyond short-term outcomes.

Sensitivity and specificity of the sensory collapse test for nerve entrapment syndrome in the upper extremity.

OBJECTIVES: Several prospective blinded studies have found poorer sensitivity for the sensory collapse test than reported by Susan E Mackinnon's team. However, the blinded examiner had no knowledge of the patient's clinical presentation, or even of the purpose of the test. In these conditions, it seems difficult to perform the sensory collapse test correctly. The aim of the present study was to evaluate the efficacy of the sensory collapse test in the diagnosis of nerve compression in the upper extremity, using a trained, "partially" blinded examiner, with a minimum of clinical information in order to avoid bias due to poor execution of the test, while still unable to influence the test result. METHODS: Seventy-two patients with diagnosis of nerve entrapment in the upper extremity were included prospectively. The sensory collapse test was performed by two examiners, one of whom was blinded to laterality and to the site of nerve compression, aware only of the affected nerve. Using electrodiagnosis study as reference, the sensitivity and specificity of the sensory collapse test were calculated for each examiner. RESULTS: The unblinded examiner showed 72% sensitivity and 57% specificity, and the blinded 68% sensitivity and 57% specificity. CONCLUSIONS: The sensory collapse test is useful for diagnosis of nerve entrapment in the upper limb, even with a blinded examiner.

Flexor tendon rupture following repeated corticosteroid injections for carpal tunnel syndrome: A case report.

INTRODUCTION: Corticosteroid injection (CSI) for carpal tunnel syndrome is a common diagnostic and therapeutic procedure. Adverse effects of corticosteroid injections are infrequent, though rare cases of flexor tendon rupture have been documented. PRESENTATION OF CASE: We present a case of a 67-year-old female with acute loss of left index finger flexion due to rupture of the left index flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) tendons and left long finger FDS tendon following numerous carpal tunnel corticosteroid injections. Intraoperatively, she was also found to have a complete rupture of the long finger FDS and partial rupture of the long finger FDP. Side-to-side tendon transfers were performed to restore the flexor tendon function. DISCUSSION: The overall incidence of serious adverse effects in patients receiving CSIs for carpal tunnel syndrome, including flexor tendon rupture, intraneural injection or gangrene, is extremely low. Only three cases of flexor tendon ruptures following CSI for carpal tunnel syndrome have been reported in the literature. Given our patient's multiple CSIs per year over the course of 6 years, she may have been at increased risk of spontaneous tendon rupture given extra-articular CSIs can result in tendon rupture as a rare, but serious complication. CONCLUSION: This case demonstrates that flexor tendon ruptures are a possible, although rare, complication following steroid injections for carpal tunnel syndrome. Proper injection techniques should be used to minimize adverse effects.

USG-Guided Percutaneous Thread Carpal Tunnel Release.

Ultrasonography (USG) is utilized for the diagnostic and interventional management of patients with carpal tunnel syndrome (CTS). The management of patients with severe and/or refractory CTS includes the surgical (open/endoscopic) release of transverse carpal ligament. With the advancements in the resolution of USG, the release of transverse carpal ligament can be done safely with the help of transecting/cutting devices. We discuss the technical report on the principle of percutaneous thread carpal tunnel release with the help of surgical grade thread.

Diagnostic Accuracy of Neuromuscular Ultrasound vs. Electrodiagnostic Studies for Carpal Tunnel Syndrome: Systematic Review and Meta-analysis of Paired Accuracy Studies.

This systematic review with meta-analysis compared the diagnostic accuracy of neuromuscular ultrasound (NMUS) and electrodiagnostic studies (EDX) as confirmatory tests for carpal tunnel syndrome (CTS) diagnosis. We used bivariate random-effects models to estimate pooled sensitivity and specificity and generate hierarchical summary receiver-operating characteristic curves to assess diagnostic test accuracy. Nine paired accuracy studies were included, representing 1751 hands (743 clinically diagnosed CTS; 1008 without CTS) that underwent NMUS and EDX. Compared to the clinical diagnosis reference standard, the pooled sensitivity was 86.4% for NMUS and 91.6% for EDX. Pooled specificity was 79.3% for NMUS and 81.9% for EDX. The positive likelihood ratios were 4.2 and 5.1 for NMUS and EDX, respectively, and the negative likelihood ratios were 0.17 and 0.10, respectively. The diagnostic odds ratio was 24 for NMUS and 49 for EDX. No statistically significant differences were identified between NMUS and EDX for sensitivity, specificity, or overall diagnostic accuracy. Overall, the diagnostic accuracy of NMUS is similar to that of EDX for CTS diagnosis, with high sensitivity and moderate specificity for each. The choice between these confirmatory diagnostic tests should incorporate shared decision-making between patients and providers that weighs diagnostic accuracy as well as factors such as patient preferences, test availability, cost, and tolerability.

An Anatomical Variant of Bilateral Persistent Median Artery and Bifid Median Nerve: A Cadaveric Case Report.

An 89-year-old Caucasian male cadaver with prostate cancer demonstrated bilateral persistence of the median artery and bifid median nerve (BMN) during upper limb dissection. The persistent median artery (PMA) originated from the common interosseous artery and coursed alongside the median nerve. Proximal to the carpal tunnel, the median nerve bifurcated into medial and lateral branches. To our knowledge, this is the first documented case of a bilateral PMA and BMN. While the majority of existing literature focuses on a unilateral PMA or unilateral BMN, bilateral occurrences of either variation are rare. This report presents a novel finding by documenting the simultaneous presence of a bilateral PMA and BMN.

Remote postoperative management using Ecological Momentary Computerized Adaptive Testing (EMCAT): feasibility assessment survey.

Our survey of 38 surgeons shows that Ecological Momentary Computerized Adaptive Testing (EMCAT), a platform to remotely collect patient-reported outcome measures (PROMs) is acceptable to surgeons, and 36 of 38 are willing to participate in future randomized control trials comparing EMCAT versus routine follow-up.Level of evidence: IV.

Causal relationship between rheumatoid arthritis and carpal tunnel syndrome: a bidirectional two-sample Mendelian randomization study.

BACKGROUND: Although there is considerable evidence of a robust correlation between rheumatoid arthritis (RA) and carpal tunnel syndrome (CTS) in previous research, the causal link between the two remains a topic of controversy. METHODS: We conducted a two-sample Mendelian randomization (MR) study to explore the causal impact of RA on CTS. We obtained aggregate data from genome-wide association studies (GWAS) of CTS (ebi database and GEO database) and RA (FinnGen database). This study employed five MR analysis methods, with a focus on the inverse variance-weighted (IVW) method. Sensitivity analyses were conducted to ensure the robustness of the results of this study. Additionally, we performed reverse MR analysis. RESULTS: We selected 84 and 78 single nucleotide polymorphisms (SNPs) significantly associated with RA from two databases as instrumental variables (IVs), respectively. Our results showed that RA patients have a higher risk of getting CTS regardless of whether the ebi database (IVW, OR = 1.045, 95% CI: 1.016-1.075, P = 0.002) or the GEO database (IVW, OR = 1.001, 95% CI: 1.001-1.002, P = 0.001) is selected for CTS data. However, the MR analysis showed no causal link between CTS and the increased risk of RA (ebi: IVW, OR = 1.084, 95% CI: 0.918-1.279, P = 0.341; GEO: IVW, OR = 1.968, 95% CI: 0.011-360.791, P = 0.799). CONCLUSION: The analysis revealed that RA can increase the risk of CTS, but did not support the causal relationship that CTS can increase the risk of RA.

Normative Data of Carpal Bone Measurements in the Sample Adult Indian Population.

Introduction Radiography is the most often accessible and affordable imaging modality. Accurate assessments of wrist X-rays can aid in the diagnosis and prognostic evaluation of various wrist problems. This study aims to identify normal radiographic anthropometry reference values and variations of carpal bones and joints by gender and age in sample Indian population, with the potential to be clinically applicable. Materials and Methods Two investigators conducted a prospective analysis of normal wrist radiographs in a single center. Radiology Information Systems and Picture Archiving and Communication Systems were used to collect standard digitized normal X-rays without significant osseous pathology over a year. We conducted measurements of length, angles, and indices in a standard posteroanterior and lateral wrist X-rays in order to establish the standard dimensions and variances based on age and gender. Results A total of 18 measurements which included eight linear measurements, eight angles, and two ratios were documented. A total of 500 X-rays of 250 males and 250 females with 125 of each in two age groups of 20 and 40 years and 41 and 60 years were evaluated. Conclusion This work is a comprehensive database of the Indian population measuring parameters in normal wrist radiographs of posteroanterior and lateral views. The results of our study indicate that men and younger individuals had a significantly higher carpal height ratio. The width of distal radial ulnar joint space was significantly lesser in older subjects. Additionally, males showed a significantly higher lunate uncovered ratio and radial height. When compared to the literature, the study revealed a significant positive ulnar variance in elderly people and women. However, we noted an overall increase in the percentage of positive ulnar variance individuals in our study. We also recorded a marginal increase in radial inclination with no variations across gender and age.

A Rare Case of Carpal Tunnel Syndrome Due to Subepineural Hematoma of Median Nerve: Diagnosis and Surgical Management.

Carpal tunnel syndrome (CTS) is a common neuropathy with various underlying causes, posing diagnostic and management challenges for healthcare providers. The condition is typically associated with repetitive strain, idiopathic factors, or anatomical variations, leading to the compression of the median nerve within the carpal tunnel. We describe a case of a 46-year-old male who presented with recurrent CTS symptoms one year after a successful carpal tunnel release surgery. The symptoms resurfaced following a minor wrist trauma, leading to pain, numbness, and hand weakness. Despite initial conservative management, including immobilization and NSAIDs, the symptoms persisted. Further investigation and exploratory surgery revealed a rare subepineural hematoma of the median nerve, which was subsequently drained, resulting in immediate and lasting symptom relief. This case demonstrates the importance of considering uncommon etiologies such as subepineural hematomas in patients with recurrent CTS and underscores the need for a thorough diagnostic approach to ensure effective treatment.