J Hand Surg Am. 2026 Jun 19:S0363-5023(26)00422-3. doi: 10.1016/j.jhsa.2026.05.012. Online ahead of print.
ABSTRACT
PURPOSE: Carpal tunnel syndrome is one of the most prevalent upper-extremity disorders. It may present unilaterally, bilaterally, or on the contralateral hand at a subsequent time to initial carpal tunnel release (CTR). We aimed to assess the incidence, timing, and factors associated with contralateral CTR at the time of an index unilateral surgery.
METHODS: We performed a retrospective chart review of 1,291 primary unilateral CTR surgeries performed from 2008 to 2013 with a minimum follow-up period of 10 years within our integrated health network. In total, 742 (58%) patients met our inclusion criteria. We conducted bivariate analyses to assess for risk factors associated with contralateral CTR. Odds ratios were calculated for variables with significant results. A Kaplan-Meier curve was generated to depict the overall cumulative rate of contralateral CTR-free survival.
RESULTS: Of the 742 patients included, 314 patients (42%) underwent contralateral CTR surgery at a median of 10.6 months (IQR 4.2 months to 2.7 years) after primary surgery. The incidence of contralateral CTR after 1, 2, 5, and 10 years is 22%, 26%, 34%, and 40%, respectively. The strongest predictor was the presence of contralateral carpal tunnel syndrome symptoms at the time of index surgery (odds ratio [OR] 7.2, P < .05). Other significant risk factors included preoperative contralateral electrodiagnostic study severity (OR 1.43 per unit increase, P < .001) and a concurrent diagnosis of trigger finger (OR 1.80, P < .05). Black race was associated with significantly lower odds of contralateral surgery (OR 0.44, P < .05).
CONCLUSIONS: The incidence of contralateral CTR surgery is substantial over long-term follow-up. The observed association among trigger finger, Black race, and contralateral CTR warrants further research. Our findings help to inform preoperative counseling for patients undergoing unilateral CTR.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
PMID:42319328 | DOI:10.1016/j.jhsa.2026.05.012