Summary
We reviewed the records of all patients with carpal tunnel syndrome who underwent carpal tunnel release by the same neurosurgeon between 1980 and 1990. Of the total 102 patients, 71 patients (70%) had bilateral symptoms. Twenty-six patients in this group (37%) underwent bilateral surgery first on the more severely affected hand, and 1 month later on the contralateral hand. The remaining 45 patients with bilateral symptoms had surgery only on the more severely affected hand, contralateral surgery being withheld for various reasons. These 45 patients were sent follow-up questionnaires to evaluate the symptoms on the hand not treated surgically. The minimum follow up time after surgery was 14 months with an overall mean follow up of 5 years. Of the 33 respondents to the questionnaire, 15 patients stated that symptoms had disappeared in the non-operated hand, 4 said that their symptoms had improved, and 11 reported that symptoms had stayed the same. Three patients eventually underwent surgery on this previously non-operated hand. Thus, 58% of those who responded stated that; without surgery, the symptoms on their contralateral hand either improved or disappeared after surgery on the other hand. We suggest that simultaneous bilateral carpal tunnel surgery may be unnecessary for some patients with bilateral symptoms.
Similar content being viewed by others
References
Attal N, Jazat F, Kayser V, Guilbaud GG (1990) Further evidence for “pain-related” behaviors in a model of unilateral peripheral mononeuropathy. Pain 41: 235–251
Barden GA (1982) Carpal tunnel syndrome — Is bilateral release at the same operative setting an appropriate consideration? Proceedings, 13th. Annual Piedmont Orthopaedic Society. Orthop Trans 6(3): 506 (abstr)
Beard L, Kumar A, Estep HL (1985) Bilateral carpal tunnel syndrome caused by Graves' disease. Arch Intern Med 145: 345–346
Bonica JJ (1979) Causalgia and other reflex sympathetic dystrophies. In: Bonica JJ, Leibeskind JC, Albe-Fessard (eds) Advances in pain research and therapy. Raven. New York, pp 141–166
Cseuz KA, Thomas JE, Lambert EH, Love JG, Lipscomb PR (1966) Long-term results of operation for carpal tunnel syndrome. Mayo Clin Proc 41: 232–241
Dawson DM, Hallett M, Millender LH (1983) Entrapment neuropathies. Little Brown, Boston, pp 1–59
Ditmars DM, Houin HP (1986) Carpal tunnel syndrome. Hand Clin 2: 525–532
Duncan KH, Lewis RC, Foreman KA, Nordyke MD (1987) Treatment of carpal tunnel syndrome by members of the american society for surgery of the hand: results of a questionnaire. J Hand Surg 12A: 384–392
Gelberman RH, Pfeffer GB, Galbraith RT, Szabo RM, Rydevik B, Dimick M (1987) Results of treatment of severe carpal tunnel syndrome without internal neurolysis of the median nerve. J Bone Joint Surg 69A: 896–903
Giesler GJ, Yezierski RP, Gerhart KD, Willis WD (1981) Spinothalamic tract neurons that project to medial and/or lateral thalamic nuclei: evidence for a physiologically novel population of spinal cord neurons. J Neurophysiol 46: 1285–1308
Gilman S, Newman SW (1992) Manter and Gatz's essentials of clinical neuroanatomy and neurophysiology, 8th ed. Davis, Philadelphia, pp 56–59
Gould JS, Wisinger HA (1978) Carpal tunnel syndrome in pregnancy. South Med J 71: 144–145
Heckler FR, Jabaley ME (1986) Evolving concepts of median nerve decompression in the carpal tunnel. Hand Clin 2: 723–736
Holmgren-Larsson H, Leszniewski W, Linden U, Rabow L, Thorling T (1985) Internal neurolysis or ligament division only in carpal tunnel syndrome — results of a randomized study. Acta Neurochir (Wien) 74: 118–121
Howard EM (1986) Controversies in nerve entrapment syndromes in the forearm and wrist. Orthop Clin North Am 17: 375–381
Inglis AE, Sträub LR, Williams CS (1972) Median nerve neuropathy at the wrist. Clin Orthop 83: 48–54
Kulick MI, Gordillo G, Javidi T, Kilgore ES, Newmayer WL (1986) Longterm analysis of patients having surgical treatment for carpal tunnel syndrome. J Hand Surg 11A: 59–66
Louis DS, Greene TL, Noellert RC (1985) Complications of carpal tunnel syndrome. J Neurosurg 62: 352–356
Mao J, Mayer DJ, Price DD (1993) Patterns of increased brain activity indicative of pain in a rat model of peripheral mononeuropathy. J Neurosci 13: 2689–2702
Mao J, Price DD, Coghill RC, Mayer DJ, Hayes RL (1992) Spatial patterns of spinal cord [14C]-2-deoxyglucose metabolic activity in a rat model of painful peripheral mononeuropathy. Pain 50: 89–100
Mao J, Price DD, Mayer DJ, Hayes RL (1992) Pain-related increases in spinal cord membrane-bound protein kinase C following peripheral nerve injury. Brain Res 588: 144–149
Marie, Pierre, Foix (1913) Atrophie isolee de l'eminence thenar d'origine nerritique. Role du ligament annulaire anterieur du carpe dans la pathogenie de la lesion. Rev Neurol 26: 647–649
O'Duffy JD, Randall RV, MacCarty CS (1973) Median neuropathy (carpal tunnel syndrome) in acromegaly. Ann Intern Med 78: 379–382
Paget J (1854) Lectures on surgical pathology, 2nd ed. Lindsay and Blakiston, Philadelphia, p 42
Pagnanelli DM, Barrer SJ (1991) Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome. J Neurosurg 75: 77–81
Pagnanelli DM, Barrer SJ (1992) Bilateral carpal tunnel release at one operation: report of 228 patients. Neurosurgery 31: 1030–1034
Paine KWE, Polyzordis KS (1983) Carpal tunnel syndrome. Decompression using the Paine retinaculatome. J Neurosurg 59: 1031–1036
Phalen GS (1951) Spontaneous compression of the median nerve at the wrist. JAMA 145: 1128–1133
Phalen GS (1966) The carpal tunnel syndrome. J Bone Joint Surg 48A: 211–228
Phalen GS (1970) Reflections on 21 years' experience with carpal tunnel syndrome. JAMA 212: 1365–1367
Phalen GS (1972) The carpal tunnel syndrome. Clin Orthop 83: 29–40
Price DD (1988) Psychological and neural mechanisms of pain. Raven, New York, pp 1–241
Price DD, Bennett GJ, Rafii A (1989) Psychological observations on patients with neuropathic pain relieved by sympathetic block. Pain 36: 273–288
Price DD, Mao J, Coghill RC, d'Avella D, Cicciarello R, Fiori MG, Mayer DJ, Hayes RL (1991) Regional changes in spinal cord glucose metabolism in a rat model of painful neuropathy. Brain Res 564: 314–318
Schiller F, Kolb FO (1954) Carpal tunnel syndrome in acromegaly. Neurology 4: 271–282
Silverstein BA, Fine LS, Armstrong TJ (1987) Occupational factors and carpal tunnel syndrome. Am J Indust Med 11: 343–358
Sokoloff L, Reivich M, Kennedy C, Des Rosiers MH, Patlak CS, Pettigrew KD, Sakurada O, Shinohara M (1977) The [14C] deoxyglucose method for the measurement of local cerebral glucose utilization: theory, procedure, and normal values in the conscious and anesthetized albino rat. J Neurochem 28: 897–916
Taleisnik J (1973) The palmar cutaneous branch of the median nerve and the approach to the carpal tunnel. J Bone Joint Surg 55A: 1212–1217
Tindall SC (1990) Chronic injuries of peripheral nerves by entrapment. In: Youmans JR (ed) Neurological surgery, 3rd ed. Saunders, Philadelphia, pp 2519–2542
Tountas CP, MacDonald CJ, Meyerhoff JD, Bihrle DM (1983) Carpal tunnel syndrome. A review of 597 patients. Minn Med 66: 479–482
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McLaughlin, M.R., Pizzi, F.J. “Sympathy pains” in carpal tunnel syndrome. Acta neurochir 138, 1094–1098 (1996). https://doi.org/10.1007/BF01412313
Issue Date:
DOI: https://doi.org/10.1007/BF01412313