Thirty-eight hands in 36 patients with recurrent or persistent carpal tunnel syndrome (CTS) were reviewed retrospectively after a mean of 51 months (range 12-86) to identify factors that may lead to poor outcomes after surgical management. Clinical assessment focused on pain and sensitivity recovery, measured with a VAS and Weber's two-point discrimination test, respectively. At the latest follow-up, we found 11 excellent, 15 good, nine fair and three poor results. The risk of fair or poor results was significantly higher in the presence of intraneural fibrosis, severe preoperative sensory deficit, neuroma of the palmar cutaneous branch of the median nerve, workers compensation claims and number of previous surgeries. This last factor also significantly increased the risk of intraneural fibrosis. Despite disappointing outcomes, identification of these factors may improve our prognostic ability for revision surgery in cases of recurrent CTS.