Complications of carpal tunnel syndrome surgery: A narrative review of clinical-diagnostic and medico-legal aspects

Median nerve compression neuropathy at the carpal tunnel is the most common nerve entrapment syndrome. Surgical opening of the carpal tunnel for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Complications, although rare, are in some cases relevant and may include intraoperative technical errors, such as median nerve injury and incomplete opening of the transverse carpal ligament with persistent or recurrent postoperative symptoms. Patients with persistent symptoms after opening the carpal tunnel must be carefully evaluated with detailed medical history and clinical objective examination, in addition to specific electroneurographic tests (EMG) and diagnostic imaging (US-MRI). Magnetic resonance imaging can reliably and objectively define the edges of the carpal tunnel, show the median nerve and the possible integrity of the transverse carpal ligament. In this paper we analyze the clinical and diagnostic characteristics of these complications with particular attention to the medicolegal aspects.