Predictors of outcomes of carpal tunnel release

Objective. To identify factors that are predictive of the outcomes of great est importance to patients-i.e., symptom relief, functional improvement, an d satisfaction with the outcomes of surgery-following carpal tunnel release . Methods. We analyzed data from the Maine Carpal Tunnel Study, a community-b ased study of the outcomes of treatment for carpal tunnel syndrome. In a co hort of patients who underwent carpal tunnel release, a preoperative physic al examination was performed and questionnaires were completed preoperative ly and at 6, 18, and 30 months postoperatively. The questionnaires assessed symptom severity, upper extremity functional limitations, mental health, g eneral physical health status, the relative severity of individual symptoms , satisfaction with the results of surgery, sociodemographic factors, and f or those subjects who were in the workforce, aspects of the work environmen t. The associations between preoperative factors and the 3 principal outcom es (symptom severity, upper extremity functional limitations, and satisfact ion with the results of surgery, all evaluated at 18 months postoperatively ) were assessed with bivariate and multivariate linear regression and logis tic regression analyses. Results. Two hundred forty-one subjects were enrolled and 188 (78%) complet ed followup surveys 18 months postoperatively. Two-thirds of the patients r eported being completely or very satisfied with the outcomes of surgery at 6, 18, and 30 months postoperatively. A range of clinical and work-related variables were associated with outcomes. In multivariate analyses, greater preoperative upper extremity functional limitation was predictive of greate r functional limitations postoperatively. Worse mental health status was si gnificantly associated with more severe symptoms and lower satisfaction. Al cohol use was also associated with more severe symptoms and lower satisfact ion. Among workers, involvement of an attorney was significantly associated with greater functional limitation, more severe symptoms, and lower satisf action. Recipients of worker's compensation who did not hire an attorney ha d generally good outcomes. Of note, physical examination parameters were no t predictive of the outcomes of surgery. Conclusion. The outcomes of carpal tunnel release in community-based practi ces are excellent. Predictors of the outcomes of surgery are disease-specif ic and generic clinical factors as well as work-related factors. The strong est predictors of less favorable outcomes are worse scores on patient-repor ted measures of upper extremity functional limitation and mental health sta tus, alcohol use, and the involvement of an attorney. Clinicians should car efully evaluate patients' functional status, mental health status, health h abits, and attorney involvement prior to performing carpal tunnel release, and discuss with patients the prognostic implications of these parameters.