From Conservative to Surgical Management in Bilateral CTS: A Case-Based Approach

Carpal Tunnel Syndrome (CTS) is a common entrapment neuropathy that occurs when the median nerve is compressed while passing through the narrow osteofibrous carpal tunnel in the wrist. Middle-aged people, especially women, are more likely to have this ailment, which can be linked to work variables, systemic comorbidities, or anatomical differences. In this case report, a 46- year-old right-handed female described six months of steadily deteriorating numbness and tingling in both upper limbs, with more severe symptoms on the left side. The symptoms greatly impacted her everyday activities, particularly at night. Clinical examination confirmed positive Phalen's test, Tinel's sign, and Durkan's compression test, indicating median nerve entrapment. Nerve conduction testing indicated bilateral CTS, with greater severity on the left. Initially, conservative treatments included corticosteroid injections, vitamin B12 and D3 supplements, wrist splinting, and activity restriction. Despite adherence, the patient's symptoms continued to worsen over time. She received surgical decompression through open carpal tunnel release. Postoperative recovery included physiotherapy to improve wrist mobility, grip strength, and reduce the chance of recurrence. This case demonstrates the diagnostic problems and therapeutic implications in addressing CTS, particularly in individuals with bilateral involvement and coexisting nutritional deficits. It also highlights the value of a gradual therapeutic approach, beginning with non-surgical techniques and moving to surgical intervention when needed. Early diagnosis and extensive management, including rehabilitation, are critical for attaining positive functional results and maintaining quality of life in patients with CTS.