Factors Correlated with Unfavorable Outcome after Carpal Tunnel Release Surgery

OBJECTIVES: Carpal tunnel release surgery has excellent results. The aim of this study was to identify which baseline clinical and demographic factors could predict a good outcome from surgery. Understanding the impact of prognostic factors will enable surgeons to indicate surgical intervention better, provide appropriate preoperative counseling, and manage expectations postoperatively. MATERIALS AND METHODS: A prospective, observational study included 620 carpal tunnel syndrome patients (age 42.38 ± 11.18 years; mean ± standard deviation). After the diagnosis had been confirmed by electrodiagnostic studies, patients underwent open carpal tunnel release surgery. Patients were evaluated initially after 2 weeks and eventually after 6 months. Surgical outcome was compared with presurgical findings. RESULTS: Response to surgery was good in 89.4% and 94.2% after 2 weeks and 6 months, respectively. Factors correlated significantly with unfavorable outcome of surgery included old age, longer duration of symptoms, negative Phalen's test, abnormal two-point discrimination test, and weakness of abductor pollicis brevis muscle. Gender, retrograde radiation, and nocturnal symptoms did not correlate with surgical outcome. CONCLUSION: Elderly patients with longstanding disease, neurological deficits, and negative Phalen's test may not respond to surgery as others. This should be kept in mind in preoperative counseling and postoperative expectations.