Persistent or Recurrent Symptoms

All surgical procedures carry some risks, which I will discuss with you in detail during your consultation. These include general risks and those specific to each condition. Revision, reconstruction, and nerve transfer procedures are more complex and will be discussed in detail according to your individual case and goals.

Expect months. Nerves grow slowly; therapy helps the brain “learn” the new pathway. We track progress together and adapt your plan.

For simple releases, usually a guided home programme; for revision, reconstruction, and transfers, formal hand therapy is essential.

Persistent symptoms are those that never fully settle after your first operation, while recurrent symptoms are problems that improve initially and then return months or years later. This can include tingling, numbness, pain, weakness, or loss of fine hand function.

Most patients experience good long-term relief after their first carpal tunnel or cubital tunnel decompression. However, a small proportion continue to have symptoms or develop recurrence over time. Only a minority of all nerve decompression procedures require revision surgery, but because these cases can be complex, they are commonly referred to specialist peripheral nerve surgeons. As a specialist, I see and treat these cases regularly.

There are several possible reasons, including:

• Incomplete release of the nerve at the first operation
• Residual or new areas of compression along the nerve
• Nerve instability or subluxation (the nerve moving abnormally with joint motion)
• Scarring and tethering around the nerve
• A very irritable or severely damaged nerve that recovers slowly or incompletely
• A different diagnosis (for example, a neck or systemic nerve problem) that was not apparent at the time of the first surgery.

A careful assessment is essential to understand which of these applies to you.

You should consider a review with a hand and peripheral nerve specialist if:

• Your symptoms never improved after surgery
• Your symptoms improved but have now returned or worsened
• You have new weakness, clumsiness, or muscle wasting
• Pain is waking you at night or affecting work, driving, or caring responsibilities
• Symptoms are progressing rather than settling over time

Sudden severe weakness or loss of hand function should be assessed promptly.

No. Revision nerve surgery is not the first step. Many patients can be managed with non-surgical measures such as splintage, nerve glide exercises, physiotherapy, optimised pain management, injections, or treating contributing conditions (e.g. diabetes, thyroid disease, neck pathology). Surgery is only considered if there is a clear structural cause, ongoing disability, and you have not responded to more conservative treatment.

Revision nerve surgery is more complex. The nerve and surrounding tissues may be scarred and distorted, so the operation often takes longer and demands advanced microsurgical and nerve techniques. In selected cases, additional procedures such as nerve wrapping, nerve grafting, tendon transfer, or bony procedures (for example, medial epicondylectomy in failed cubital tunnel surgery) may be needed to restore space and stability for the nerve.

Outcomes after revision surgery can be very good, but they are usually less predictable than after primary surgery. Pain and night waking often improve, but long-standing numbness or muscle wasting may not fully recover, particularly in conditions such as long-standing cubital tunnel syndrome. Realistic goals and a frank discussion of likely benefits and limitations are a key part of your consultation.

You may be offered:

• Updated nerve conduction studies and EMG
• Ultrasound to assess nerve swelling, scarring, or instability
• X-rays or MRI if there is concern about bone, joint, or neck involvement

These tests help confirm the diagnosis, identify the exact level of compression or scarring, and ensure that a revision procedure is likely to help.

The usual surgical risks—such as infection, bleeding, stiffness, or CRPS—still apply. Revision nerve surgery also carries some additional considerations, including:

• A slightly higher risk of nerve irritation or injury due to existing scar tissue
• The possibility of persistent or recurrent symptoms
• A small chance that further procedures may be needed

Because revision operations are more complex, they are generally carried out by surgeons with dedicated training in peripheral nerve and microsurgical techniques. My own practice is shaped by formal peripheral nerve and microsurgery fellowships completed in leading centres in the UK and abroad.

Often, yes. Revision procedures can involve larger exposures, more delicate dissection, and sometimes additional soft-tissue or bony procedures, so swelling and recovery can be slower. Time off work will depend on:

• The specific nerve and operation performed
• Whether your job is desk-based or physically demanding
• Whether both hands or arms are affected

Your post-operative plan will be tailored to your occupation and lifestyle, with a phased return to work whenever possible.

You may be a candidate if you have:

• Ongoing or recurrent symptoms that significantly limit daily life
• Objective findings on examination and tests that match your symptoms
• An identifiable cause on imaging / nerve studies that can be addressed surgically
• Tried appropriate non-surgical measures without sufficient improvement

During a consultation, I will review your previous operation notes, examine your hand and arm in detail, and go through your investigation results to decide together whether revision surgery is appropriate and in your best interests.