Factors associated with the preoperative electrophysiological severity of carpal tunnel syndrome and correlation with early postoperative hand function status

Objective To investigate factors associated with preoperative electrophysiological severity in carpal tunnel syndrome (CTS) and the correlation between electrophysiological severity and early postoperative hand function status. Methods A total of 148 patients with CTS diagnosed by clinical examination, nerve conduction studies and supplementary electromyography in the study hospital between 1 January 2024 and 1 December 2024 were retrospectively enrolled in this study. Based on preoperative electrophysiological severity, CTS patients were split into mild, moderate, and severe groups. At 3 weeks post-treatment, we collected demographic data, anthropometric measurements, and scores from the LCTQ, PRWE, and DASH questionnaires. Statistical analyses included one-way ANOVA, chi-square tests, and ordinal logistic regression. Results With the escalation of disease severity, disease duration (14.66 ± 5.59 vs. 27.35 ± 11.67 vs. 34.81 ± 11.22, p < 0.001) and transverse carpal diameter (36.68 ± 3.03 vs. 38.78 ± 2.76 vs. 40.92 ± 2.89, p < 0.001) increased progressively, whereas the ratio of wrist circumference to transverse carpal diameter decreased (4.24 ± 0.39 vs. 4.07 ± 0.39 vs. 3.92 ± 0.38, p < 0.001). The ordinal logistic regression showed that disease duration, transverse carpal diameter and wrist circumference/transverse carpal diameter were independent factors associated with electrophysiological severity (omnibus test: p < 0.001, Nagelkerke pseudo R 2 = 0.622). Preoperative LCTQ, PRWE and DASH scores were significantly higher in the severe group than in the mild or moderate groups (all p < 0.001). At 3 weeks postoperatively, all scores were significantly improved from baseline (all p < 0.001) but still differed across groups. Correlation analysis revealed that LCTQ ( r = 0.63), PRWE ( r = 0.42) and DASH ( r = 0.87) results were all positively correlated with preoperative electrophysiological severity. Conclusion Disease duration, transverse carpal diameter and the ratio of wrist circumference to transverse carpal diameter were associated with electrophysiological severity in patients with CTS, with longer disease durations, larger transverse carpal diameters and smaller wrist circumference-to-transverse carpal diameter ratios corresponding to greater electrophysiological severity and poorer early postoperative function statuses.