The carpal tunnel syndrome is a

bilateral disorder
 history
The journal study from 131 pasient with CTS,
229 hands pasient need to surgery
More than 60-87% case of the CTS present
both side
Symtoms usually more severe on one side
Patients and Methods

From 131 patients cts with age of 48 years (33-

69) , 112 women and 19 men

They have to criteria for CTS

inclusion criteria
Exclusion criteria
Clinical diagnosis of CTS in the 131 patients who had open carpal tunnel release

Number of patients percentage

Nocturnal pain 113 86
and
paraesthesiac
Activity-related 80 61
pain
Sensory deficit 43 33
Loss of hand grif 73 56
stenar muscles
Atrophy of thenar 79 60
muscle
Positive Phalens 93 71
test
Positive Tinels 88 67
sign
Distribution of symptoms in the 131 patients before
open carpal tunnel releas

Number of patients
Bilateral symptoms 77
More symptoms is one hand 46
In the dominant hand 33
In the non-dominant hand 13
Equal symptoms in both 31
hands
Unilateral symptoms 54
In the dominant hand 39
In the non-dominant hand 15
Results

Electrodiagnostic tests revealed positive

results in both hands in all of the 77 patients
with bilateral symptoms
9 patients showed absence at least 1 digit
sensory and motor response.
Results of nerve-conduction studies for the 131 patients with idiopathic CTS
SNCV (m/s)
Number of DML First digit to wrist Third digit to wrist
patients
Bilateral symptoms 77
Overall 77 5.8 32.4 34.5
more symptoms in one 46 6.0 31.5 33.3
hand
More severe side 37 6.7 30.6 31.9
Absence of SNAP 8 7 - -
Absence of motor 1 - - -
response
Less severe side 46 5.4 32.8 34.9
Equal symptoms in both 31 5.4 33.4 35.6
hand
Unilateral symptoms 54
Symptomatic hands 54 5.2 34.2 38.6
Contralateral 54 4.3 39.1 37.5
asymptomatic hands
Positive 31 4.8 36.1 36.9
electrodiagnostic test
Negative 23 3.9 42.8 44.3
electrodiagnostic test
Needle EMG results for the 131 patients with idiopathic CTS

Number of patients pecentage

Bilateral symptoms 77 100
Both hands positive 59 77
One hand positive 10 13
Both hands negative 8 10

Unilatera symptoms 54 100

Symptomatic hand positive 36 67
Symptomatic hand negative 18 33
Asymptomatic hand positve 2 4
Asymptomatic hand 52 96
negative
 Comparison of nerve conduction studies in 13 patients who had,
initially, negative electrodiagnostic test results, but in whom later
tests showed neurophysiological impairment of the median nerv

SNCV (m/s)

Number of DML First digit to Third digit

patients (m/s) wrist to wrist

First test 13 3.2 42.3 44.1

Second 13 5.6 34.5 35.9

test
Discussion
patients with CTS usually complain of bilateral
symptoms
the incidence of bilateral symptoms has been
reported to be between 60% and 87%, and was
59% at the first visit in our study
unilateral symptoms, more than half sensitive
electrodiagnostic test.
Unilateral symptoms should be monitoring both
of clinically for asymtomatic bilateral.