Associations Between Preoperative Diagnostic Tests and Surgical Recommendation for Carpal Tunnel Syndrome.

Purpose: To identify which preoperative diagnostic findings, individually and in combination, are most strongly associated with a surgeon's recommendation for carpal tunnel release. Methods: This retrospective cohort study included 313 wrists from 218 patients evaluated for carpal tunnel syndrome (CTS) by one of three surgeons at a tertiary academic center between 2012 and 2020. Each wrist had a documented surgical recommendation and complete preoperative data, including CTS-6 score, ultrasound median nerve cross-sectional area (CSA), and at least one nerve conduction study parameter. Demographic variables, such as age, sex, and body mass index, were also analyzed. Nerve conduction study parameters included distal motor latency (DML), distal sensory latency (DSL), compound muscle action potential, and sensory nerve action potential (SNAP). Associations with surgical recommendation were examined using generalized estimating equation logistic regression. Models were compared by the area under the receiver operating characteristic curve and evaluated for sensitivity, specificity, positive predictive value, and negative predictive value. Results: All six diagnostic tests were significantly associated with surgical recommendation on univariable analysis (all Conclusions: Surgical recommendation for CTS is influenced by complementary diagnostic information across clinical, physiologic, and anatomic domains. CTS-6, DML, and CSA were most consistently associated with surgical recommendation, highlighting the value of a multimodal diagnostic framework that integrates clinical, electrodiagnostic, and ultrasound findings when assessing surgical candidacy. Type of study/level of evidence: Diagnostic III.