title: Simultaneous Bilateral or Unilateral Carpal Tunnel Release? A Prospective Cohort Study of Early Outcomes and Limitations.
abstract: BACKGROUND
  Over 60% of patients with carpal tunnel syndrome present with symptoms and findings of nerve compression in both hands. Our goal was to compare patient-rated difficulties in performing activities of daily living in the early postoperative period between those undergoing bilateral carpal tunnel release and those undergoing unilateral carpal tunnel release.
  
  
  METHODS
  This prospective cohort study enrolled consecutive patients with bilateral carpal tunnel syndrome undergoing bilateral carpal tunnel release (n = 47) or unilateral carpal tunnel release (n = 41). Patient function and disease severity were measured by an abbreviated form of the Disabilities of the Arm, Shoulder and Hand questionnaire, QuickDASH, and the Boston Carpal Tunnel Questionnaire at baseline, at postoperative visit 1 at a mean time (and standard deviation) of 10 ± 3 days, and at postoperative visit 2 at a mean time (and standard deviation) of 30 ± 6 days. Patients rated their difficulty in completing fifteen activities of daily living each day for the first postoperative week. Patients reported the factors that influenced their choice of surgery.
  
  
  RESULTS
  There was no difference in baseline function or disease severity between the two groups with regard to QuickDASH and the Boston Carpal Tunnel Questionnaire. Patients in both groups improved after carpal tunnel release with no difference between groups either at postoperative visit 1 for QuickDASH (p = 0.97) and the Boston Carpal Tunnel Questionnaire (p = 0.86) or at postoperative visit 2 for QuickDASH (p = 0.43) and the Boston Carpal Tunnel Questionnaire (p = 0.34). Patients undergoing bilateral carpal tunnel release had more difficulty only during postoperative days 1 to 2 in opening jars (p = 0.03), cooking (p = 0.008), and doing household chores (p = 0.02). Patients in the two groups did not differ (p > 0.05) in their abilities to perform activities of daily living necessary for personal hygiene or independence on any day during the first seven days following surgery with regard to using the bathroom, bathing, dressing, or eating. Although the most common reason why patients chose bilateral carpal tunnel release was to avoid two surgical procedures (42%), the most common reason why patients chose unilateral carpal tunnel release was concern for self-care (36%).
  
  
  CONCLUSIONS
  Patients with bilateral carpal tunnel syndrome can anticipate more severe functional impairment during the first few postoperative days with bilateral carpal tunnel release compared with unilateral carpal tunnel release, but limitations beyond postoperative day 2 or 3 are similar for bilateral and unilateral carpal tunnel release.
  
  
  METHODS
  Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery (D.A.O., R.P.C., M.I.B., C.A.G., and R.H.G.), Washington University School of Medicine (J.G.S.), 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wustl.edu.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Osei
authors.affiliation: Department of Orthopedic Surgery (D.A.O., R.P.C., M.I.B., C.A.G., and R.H.G.), Washington University School of Medicine (J.G.S.), 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wustl.edu.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
authors.affiliation: Department of Orthopedic Surgery (D.A.O., R.P.C., M.I.B., C.A.G., and R.H.G.), Washington University School of Medicine (J.G.S.), 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wustl.edu.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Stepan
authors.affiliation: Department of Orthopedic Surgery (D.A.O., R.P.C., M.I.B., C.A.G., and R.H.G.), Washington University School of Medicine (J.G.S.), 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wustl.edu.
authors.forename: Martin I
authors.initials: MI
authors.lastname: Boyer
authors.affiliation: Department of Orthopedic Surgery (D.A.O., R.P.C., M.I.B., C.A.G., and R.H.G.), Washington University School of Medicine (J.G.S.), 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wustl.edu.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Goldfarb
authors.affiliation: Department of Orthopedic Surgery (D.A.O., R.P.C., M.I.B., C.A.G., and R.H.G.), Washington University School of Medicine (J.G.S.), 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address for D.A. Osei: oseid@wustl.edu.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Gelberman
mesh_terms: D000203:Activities of Daily Living; D002349:Carpal Tunnel Syndrome / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome