Return-to-Work and Early Functional Recovery Following Office-Based Ultrasound-Guided Microinvasive Carpal Tunnel Release: A Prospective Cohort Study

Background and Objectives: Carpal tunnel release (CTR) has evolved toward increasingly less invasive techniques, with the aim of reducing procedural trauma and accelerating recovery. While ultrasound-guided and microinvasive approaches have demonstrated safety and technical precision, prospective data describing Return-to-Work (RTW) and early functional recovery remain limited. Materials and Methods: This prospective cohort study included adults undergoing office-based ultrasound-guided microinvasive CTR (Micro-CTR) under local anaesthesia using a retractable needle-mounted blade system. Patient-reported outcomes were collected using the Comprehensive Carpal Tunnel Recovery Questionnaire. The primary outcome was time to RTW. Secondary outcomes included change in pain score, analgesic duration, and time to return to driving and household tasks. Continuous outcomes were non-normally distributed and are reported as medians with interquartile ranges (IQRs). Recovery outcomes were compared by structured self-reported postoperative-event status using non-parametric and time-to-event analyses, and an exploratory distributional analysis assessed the influence of longer self-reported RTW intervals on the overall recovery distribution. Results: Sixty-seven patients were included. Median RTW was 9 days (IQR, 30.5; n = 48), with a median return to driving at 5 days (IQR 6) and household tasks at 7 days (IQR 7). Median pain decreased from 8/10 preoperatively to 0/10 postoperatively (p < 0.0001). Participants reporting at least one structured postoperative event had longer RTW intervals than those selecting no structured event (median 35 vs. 5 days; HR 0.42, 95% CI 0.22–0.80; p = 0.0079). Exploratory distributional analysis showed that longer RTW intervals had a substantial influence on the overall RTW distribution; the full RTW responder cohort remained the primary analysis. Conclusions: Ultrasound-guided Micro-CTR was associated with rapid early functional recovery in most patients in this prospective cohort. Recovery was heterogeneous, with longer RTW intervals observed among participants reporting structured postoperative events. These findings support RTW as a pragmatic functional endpoint in evaluating emerging CTR techniques.