Objective Preoperative Prognostic Tools for Predicting Recovery After Carpal Tunnel Decompression: a Systematic Review

Abstract

Carpal tunnel syndrome (CTS) is commonly treated with surgical release of the transverse carpal ligament. However, predicting postoperative recovery remains challenging. To summarise the current relationship between preoperative objective severity measures and postoperative recovery and direct the development of future research, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. MEDLINE, Embase, Scopus, CENTRAL, CINAHL and Web of Science were searched from database inception to April 19, 2026. Seventeen studies (1997-2024) were included in this review. Nerve conduction studies (NCSs) were the most common preoperative modality, followed by ultrasound, electromyography and carpal tunnel pressure. Eleven studies reported an association between preoperative severity and clinical outcome, whereas 6 studies found no association. Notably, non-NCS modalities demonstrated positive associations; however, they were underrepresented in the literature. This review provides important insight into the relationship between objective preoperative CTS severity and recovery. More importantly, it provides guidance on the research required to establish the relationship and direct patient counselling.