Early Recovery Trajectories Predict Achievement of a Patient-Acceptable Symptom State After Open and Endoscopic Carpal Tunnel Release.

PURPOSE: Carpal tunnel syndrome is commonly treated with open (OCTR) or endoscopic carpal tunnel release (ECTR), both effective for long-term symptomatic relief. However, early recovery trajectories and the prognostic value of short-term postoperative improvements remain poorly understood. Although prior studies have emphasized minimum clinically important difference (MCID), fewer have assessed higher, patient-centered benchmarks such as patient-acceptable symptom state (PASS) and substantial clinical benefit (SCB). This study evaluated the timing and rates at which patients undergoing OCTR and ECTR achieve MCID, PASS, and SCB, and whether early postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity (UE) scores can predict outcomes through 4 months.

METHODS

This retrospective cohort study included patients undergoing unilateral OCTR or ECTR who completed PROMIS UE questionnaires before surgery and at 2 weeks, 1 month, 2 months, and 3 months after surgery. Patients with bilateral, revision, or combined procedures were excluded. Time-to-event analyses using Kaplan-Meier methods estimated cumulative incidence and compared rates of MCID, PASS, and SCB achievement between cohorts. Receiver operating characteristic (ROC) analysis determined optimal 2-week PROMIS UE thresholds for predicting PASS achievement by 4 months among patients with complete follow-up.

RESULTS

A total of 152 patients were included (OCTR n = 74; ECTR n = 78), with 76% completing all follow-up timepoints. Compared to OCTR patients, ECTR patients were more than twice as likely to achieve PASS at any time through 4 months postoperatively, resulting in a higher proportion of patients reaching PASS. Nonetheless, both groups reported similar proportions of patients achieving MCID and SCB. A 2-week PROMIS UE score ≥ 34 predicted achievement of PASS by 4 months with excellent discrimination (area under the curve = 0.86), 77% positive predictive value, and 82% negative predictive value.

CONCLUSIONS

Both OCTR and ECTR provide effective functional restoration within 4 months. However, ECTR confers an early advantage in recovery, with patients reaching PASS quicker and more often than OCTR patients. Regardless of the surgical technique utilized, early postoperative-PROMIS UE scores offer valuable prognostic information in identifying patients at risk for delayed functional recovery, potentially supporting targeted follow-up and proactive rehabilitation.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.