Symptoms of numbness and burning, clumsiness, and pain in the ulnar side of the hand usually occur at the same time as the symptoms on the opposite side of the hand; i.e. the same time as a person with carpal tunnel syndrome. To a large extent, it is a moot point except when it comes to excluding ulnar nerve entrapment at the cubital tunnel. This is because carpal tunnel release simultaneously decompresses the ulnar nerve in Guyon's canal. Guyon's canal ( the ulnar tunnel) is directly adjacent to the carpal tunnel separated by a septum. As far as I can discern, the relief of the symptoms occurs much like the relief experienced by a person sitting in the front seat of a bench-type car seat when extra occupants beyond the normal two leave; i.e. when three or four are sitting on the seat designed for two passengers, there is much more space available for the remaining passengers when the couple of those squeezed in are allowed to leave. When we open up the carpal tunnel, we are widening it. According to research done on CT and MRI scans, we are increasing the size of the carpal tunnel about 25% and eliminating the pressure. It is extremely uncommon to have to perform isolated ulnar tunnel decompression; i.e. ulnar tunnel syndrome as an isolated entity does not occur very often and when it does, we need to be wary of a possible ganglion in the canal. It is also unnecessary to separately open up the ulnar tunnel at the time of carpal tunnel release surgery. This has been well established in the medical literature. Richman and Gelberman in 1989 on the basis of what appeared to be quite limited study concluded that ulnar nerve decompression at the time of carpal tunnel release occurred because of the change in the shape of Guyon's canal with the decompression; i.e. it's change from a trapezoid to more of an oval, giving it relief. I have seen many MRI scans of patients pre- and post carpal tunnel release for other reason, and I have yet to see a configuration similar to that which they published in their article. I do not believe that their specific interpretation (change in shape from a trapezoid to an oval ) is as likely as the one I have indicated above.