Flexor tendon subluxation and attritional tear following open carpal tunnel release: a report of three cases and literature review

Despite the high prevalence of carpal tunnel syndrome and extensive clinical research on carpal tunnel release (CTR), late-onset subluxation and attritional tearing of the flexor tendons after CTR have rarely been reported. We present three cases of delayed-onset flexor tendon pathology involving four wrists, characterized by attritional tearing and subluxation; all cases required revision surgery. Favorable outcomes were achieved after revision surgery, including excision of the hook of the hamate or reconstruction of the ruptured flexor tendon. Based on our findings, contributing factors may include excessive ulnar-sided dissection, lack of early postoperative immobilization, and anatomical predisposition. Although rare, flexor tendon pathology can occur even after technically uncomplicated CTR and may cause substantial morbidity. Careful surgical technique and temporary wrist immobilization in a neutral position may help prevent these complications.