title: Outcomes in carpal tunnel syndrome: symptom severity, conservative management and progression to surgery.
abstract: OBJECTIVE
  This study investigated the relationship between severity of symptoms and success of nonoperative and operative treatment in patients with carpal tunnel syndrome (CTS).
  
  
  METHODS
  An observational cohort study regarding the management of CTS was conducted. Thirty patients referred to a tertiary hand centre with a diagnosis of CTS were prospectively followed. Twenty-five of the patients (47 affected hands) were available for long-term follow up to determine management outcomes. Self-report symptoms and physical impairments were assessed and documented at baseline, 6 weeks, and 12 weeks using the CTS Severity Score (SSS), the Disability-Shoulder, Arm and Hand Score (DASH), and the Levine Functional Score. Longer-term follow-up was conducted to identify status on outcome measures and whether patients proceeded to surgery.
  
  
  RESULTS
  Those who proceeded to surgery (n = 27/47 hands) had higher initial CTS SSS and DASH scores and also maintained higher scores compared to those who improved with conservative management (p < 0.05). Improvements occurred in the SSS (P < 0.0001), Functional Score (P < 0.001), and DASH score (P < 0.05) following surgery in the patients resistant to conservative management. Recovery of grip and dexterity was less satisfactory.
  
  
  CONCLUSIONS
  This study suggests that the SSS is useful in the triage of patients on surgical wait-lists as patients with high initial scores or failure to change in short-term follow-up are likely to proceed to surgical release. Despite prolonged symptoms and previous treatment, patients with lower SSS scores had moderate success with a second trial of conservative management.
authors.affiliation: Dept. of Surgery, University of Western Ontario, London, Ontario, Canada.
authors.forename: Kirsty U
authors.initials: KU
authors.lastname: Boyd
authors.forename: Bing Siang
authors.initials: BS
authors.lastname: Gan
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Ross
authors.forename: Robert S
authors.initials: RS
authors.lastname: Richards
authors.forename: James H
authors.initials: JH
authors.lastname: Roth
authors.forename: J C
authors.initials: JC
authors.lastname: MacDermid
mesh_terms: D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index