Efficacy of Surgical Management Among Patients With Carpal Tunnel Syndrome Not Responding to Medical Management

Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, resulting from the compression of the median nerve within the carpal tunnel at the wrist. It is frequently encountered in clinical practice and often presents with symptoms such as numbness, tingling, pain, and hand weakness, particularly in the distribution of the median nerve. In many cases, conservative management - including wrist splinting, activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), and local corticosteroid injections - can lead to symptom resolution. However, a subset of patients remains symptomatic despite prolonged non-operative treatment and eventually requires surgical decompression. This study aims to evaluate the functional outcomes of carpal tunnel release (CTR) in patients who failed to respond to medical therapy. Methods A prospective observational study was conducted at GSVM Medical College on 50 patients diagnosed with CTS who did not achieve symptom relief following at least six months of conservative management. All patients underwent open carpal tunnel release surgery under local anesthesia. Outcome measures were recorded both pre- and post-operatively using three validated tools: the Visual Analog Scale (VAS) for pain assessment, the Boston Carpal Tunnel Questionnaire (BCTQ) for functional status and symptom severity, and nerve conduction velocity (NCV) studies to assess median nerve function. Follow-up assessments were performed at regular intervals, with the final evaluation at six weeks post-surgery. Results Of the 50 patients, 47 (94%) showed marked improvement in symptoms and function. The mean VAS score decreased from 7.4 to 1.5, and NCV improved from 38.5 m/s to 44.7 m/s. The functional outcomes based on BCTQ scores indicated significant recovery, and most patients reported high levels of satisfaction. The mean return-to-work time was 11.2 days. Minor complications were noted in 4% of patients, with no major adverse events. Conclusion CTR is a safe and effective treatment for CTS patients unresponsive to conservative therapy, offering significant symptom relief, enabling functional improvement and facilitating an early return to activity with minimal complications.