External Neurolysis and Hypothenar Fat Pad Flap With Early Nerve Gliding Exercise Regimen for Recurrent Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper extremity and is most often treated successfully with surgical release of the median nerve. However, some patients continue to experience symptoms or develop recurrence, which presents a management challenge. The pathophysiology of recurrent CTS may involve perineural fibrosis, iatrogenic injury, incomplete release, or unrelated neuropathic conditions such as diabetic or hereditary neuropathies. Management depends on patient history, examination, and clinical factors, with many requiring revisional surgery to relieve compression and protect the nerve. External neurolysis and hypothenar fat pad flap procedures can release the median nerve while providing soft tissue coverage to reduce scar adhesion. This report presents two cases of recurrent CTS treated successfully with this approach, highlighting its potential value as a treatment option and the importance of meticulous surgical technique and postoperative care.