gms | German Medical Science

Objectives/Interrogation: Several prognostic studies have been published which identify predictors for success in carpal tunnel syndrome (CTS) treated either operatively or by steroid injection. However, not all patients undergo surgical or non-surgical treatment or indeed need it. The purpose of this study was to describe the outcome of untreated CTS and explore what factors assessed at baseline are predictive of symptom severity at 18 months follow-up.

Methods: We conducted a prospective cohort study of patients diagnosed with CTS between 2013 and 2017 and followed up every 6 months up to 1.5 years. Data were collected through patient reported questionnaires including sociodemographics, clinical symptom severity using the shortened Boston Carpal Tunnel Questionnaire (BCTQ), hand function, general, physical and psychological health and quality of life. A general linear model was used to identify independent, baseline predictors of BCTQ symptom score at 18 months

Results and Conclusions: A total of 626 patients were enrolled into the study. Of these 161 (25%) did not receive a steroid injection or surgery for their CTS over an 18 months follow- up and were included in this analysis. The median electrodiagnostic severity in this sub-group was grade 2 (mild). Mean baseline symptom severity assessed by shortened BCTQ was 2.4 (SD=0.82) decreasing to 1.8 (SD=0.83) by 18 months. The majority (68%) were female and the mean age was 58.5 years (SD=12.3). Over 41% had reported symptoms for more than a year.

Four independent baseline predictors of higher BCTQ at 18 months were identified: higher BCTQ scores at baseline (p<0.001), higher levels of comorbidity (p=0.009), female sex (p=0.005), and the absence of diabetes (p=0.027).

Where patients decline treatment or surgical intervention has become subject to restrictive policies, the predictive factors identified from this study will help to inform likely prognosis and aid shared decision-making.