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Thinking Twice about Carpal Tunnel Surgery

When carpal tunnel syndrome (CTS) affects both wrists and hands, it is called bilateral CTS. Is it better to operate on one wrist at a time, or treat both wrists at once? Which approach is best in terms of return to work? And what kind of anesthesia should patients have for this surgery: local (only the area is numb), general block (entire arm is numb), or general (patient is asleep)?

To help answer these questions, surgeons studied two groups of patients with bilateral CTS. One group had surgery on one wrist at a time. This is called a staged procedure. The other group had both wrists operated on at once. The surgeons then compared the outcomes.

Surgery was safely performed with local anesthesia. There were many advantages to having both wrists operated on at the same time. For patients who had both wrists treated at once, recovery time was reduced. Medical costs were also reduced with only one hospital visit. And there were fewer doctor visits. Patients who had both wrists treated at once didn't have to decide whether to work between surgeries. Time and paperwork devoted to return-to-work issues was much less. For these reasons, many doctors recommend operating on both wrists at once for bilateral carpal tunnel syndrome.

References: Edward V. Fehringer, MD, et al. Bilateral Endoscopic Carpal Tunnel Releases: Simultaneous Versus Staged Operative Intervention. In Arthroscopy. March 2002. Vol. 18. No. 3. Pp. 316-321.

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