This case involves a middle-aged male patient with a history of rheumatoid arthritis who presented with persistent hand inflammation. He underwent an endoscopic carpal tunnel release after months of conservative management failed to improve his condition. During the procedure, the surgeon lacerated the median nerve. Following the surgery, the patient developed a painful neuroma at the laceration location. The neuroma caused persistent electrical pain in the affected hand and the patient suffered difficulty performing routine daily tasks he had no problem with prior to the surgery. The patient was told by the surgeon that injury to the median nerve was an unavoidable complication and that nothing could have been done to prevent these side effects from occurring. An expert hand surgeon was sought to opine on whether such injuries are inevitable.
Question(s) For Expert Witness
- 1. How often do you perform endoscopic and/or open CTR?
- 2. What precautions are taken to protect the median nerve during endoscopic CTR?
- 3. Have you ever seen this complication before or reviewed a similar case? If yes, please elaborate.
Expert Witness Response E-035992
I am the section director of hand surgery and an assistant program director of plastic surgery at my institution. I have performed several endoscopic carpal tunnel releases in my training. At the present time, I perform over 100 open carpal tunnel releases per year. The nerve should be visualized during the entire release to prevent injury. Clearly, this was not done. Direct injury to the median nerve after carpal tunnel release is exceedingly rare. While most may consider it a risk of the surgery, the injury is so significant that can be quite debilitating. I have written an opinion in a similar case where I felt there was a deviation. Also, if the patient was not warranted that median nerve laceration could occur, this would be a deviation in the form of informed consent.