Although it is possible to perform innovative surgery treatment of various maladies affecting the human body, in some cases, it is not always reasonable or practical to do so. A recent example of this view is a current recommendation to perform bilateral surgical intervention for symptomatic carpal tunnel syndrome. Carpal tunnel syndrome is the most common upper-limb compressive neuropathy1, as recently reaffirmed in this study by Osei and colleagues comparing patients undergoing simultaneous bilateral carpal tunnel release and those undergoing unilateral carpal tunnel release. Many presentations of carpal tunnel syndrome, especially in patients with diabetes, hypothyroidism, and inflammatory arthritis, have bilateral involvement1,2. Since it was first described by Phalen et al. in 19503, there have been several different surgical techniques described for carpal tunnel release. The classical incision begins in the palm and crosses the wrist flexion crease4. This extended incision is recommended when there has been a distal radial fracture or when synovectomy for inflammatory arthritis or other tendinopathies is considered. Small palmar incisions (2-cm length) and even mini-incisions and endoscopic procedures can be applied to divide the transverse carpal ligament, but perhaps with less certainty as to the specific area of ligament division, especially with respect to the ulnar border of the carpal ligament adjacent to the hook of the hamate2-6. The location of the incision (more ulnar than radial) may be important to avoid a healing carpal ligament (scar) directly adjacent to the median nerve. Following surgery, there are also different opinions as to the need to immobilize the wrist to ensure ligament healing, prevent soft-tissue interposition, and provide normal tendon gliding through the palmar pulley (transverse carpal ligament). Wrist immobilization may also be of benefit to limit overuse by the patient in …