Early Electrophysiological Recovery After Carpal Tunnel Release in Severe Carpal Tunnel Syndrome With Absent Preoperative Nerve Potentials.

BACKGROUND: In severe cases of carpal tunnel syndrome (CTS), compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) may be absent on preoperative nerve conduction studies (NCS), reflecting advanced nerve damage. Although clinical improvement after carpal tunnel release is common, early electrophysiological recovery in this subgroup and its predictive factors remain poorly defined. This study investigated reappearance of CMAP and SNAP within 3 months after surgery and explored predictors of recovery.

METHODS: This study included 53 patients with CTS who demonstrated absent CMAP and/or SNAP preoperatively and underwent open carpal tunnel release. All patients had NCS performed within 3 months before surgery and again at 3 months postoperatively. Patients were categorized into recovery and nonrecovery groups based on reappearance of CMAP and/or SNAP. Demographic variables, disease duration, and laboratory parameters were compared between groups. A multivariable logistic regression analysis was performed to identify independent predictors of electrophysiological recovery.

RESULTS: At 3 months postoperatively, a subset of patients demonstrated recovery of CMAP and/or SNAP. In the multivariable analysis, younger age (P < .01) and higher body weight (P = .04) were independently associated with SNAP recovery, whereas age showed the strongest association with CMAP recovery but did not reach statistical significance. Symptom duration and metabolic laboratory parameters were not independently associated with recovery.

CONCLUSIONS: Early electrophysiological recovery is achievable even in severe cases of CTS with absent preoperative nerve potentials. Younger age is the strongest predictor of early recovery. These findings provide clinically relevant prognostic information for patients undergoing surgical treatment for advanced CTS.