BILATERAL CARPAL TUNNEL SYNDROME: WHAT HAPPENED TO THE OTHER HAND?

Abstract

Introduction: Carpal tunnel syndrome is the most commonly occurring peripheral nerve entrapment syndrome and perhaps also the commonest peripheral nerve to be released. Increasingly there is a suggestion that carpal tunnel syndrome (CTS) is a bilateral disease with the reported incidence of between 16% and 87% and hence the enthusiasts favour bilateral simultaneous carpal tunnel decompression (CTD). Our hypothesis is that there is an increased likelihood of over-treating these patients with this approach of simultaneous carpal tunnel decompression.

Materials and Methods: A retrospective study was conducted to review records of 245 patients who underwent CTD at the Regional Hand Surgery Unit between April 2005 and August 2007. Patients who were referred with symptoms of bilateral CTS and underwent open CTD on at least one wrist were included in the study. The two groups hence formed were Group A comprising patients who underwent consecutive CTD where as Group B comprised patients who underwent only unilateral CTD before discharge. All patients booked for surgery were provided with a resting splint preoperatively. They were reviewed on one or more occasion before listing for decompression on the other side or discharged.

Results: A total of 131 met the inclusion criterion. Group A includes 76 (58%) patients and had symptoms on both sides and signs in 64 (84%) patients. Nerve conduction tests confirmed median nerve compression in 59/60 (98%) patients. Group B includes 55 (42%) patients and had symptoms suggestive of CTS on both sides and signs in 45 (82%) patients. Nerve conduction studies confirmed nerve compression in 38/41 (93%) patients. All patients were followed up for minimum of 6 months before being discharged from further review. At the end of the study, 48/131 (37 %) patients were successfully discharged after a minimum of six months follow up without an operation on the contralateral side.

Discussion: Our study has confirmed the bilateral nature of the disease. Current literature supports simultaneous CTD as it has been shown to be economic to the patient, employers and the healthcare industry. Studies have shown that symptoms are usually severe on one side and sometimes treatment of one hand may lead to the improvement, exacerbation or absence of effect in the other hand regardless of electromyographic findings. 45/131 (37 %) patients in our study were successfully discharged without an operation on the contralateral side after a minimum of six months follow up. Hence, this supports our hypothesis that by following an approach of simultaneous bilateral CTD, there is a increased likelihood of over-treating these patients and exposing them to the potential complications.