Management Patterns, Outcomes, and Timing Differences in Carpal Tunnel Syndrome Treatment: A Retrospective Review at a Single Institution from 2019-2024.

Background: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy that may be managed with conservative therapies and/or surgical decompression. Although both strategies are routinely used, limited data exists on how management patterns evolve within individual healthcare systems over time. This study examined trends in CTS treatment utilization, timing to surgery, and patient outcomes over a five-year period. Methods: A retrospective cohort study of adult patients diagnosed with CTS at the Carle Health System between September 1st, 2019 and September 1st, 2024 was conducted. Eligible records were identified through the electronic medical record and manually reviewed. Data collected included non-surgical and surgical treatments used, symptom improvement, follow-up completion, and timing intervals for injections and carpal tunnel release (CTR). Descriptive statistics were generated, and Fisher's exact and Kruskal-Wallis tests were used to explore annual differences. All inferential analysis were considered exploratory due to small sample size. Results: Of 516 identified patients, 62 met inclusion criteria. Across the study period, the proportion of patients receiving wrist splinting (43-73%) and CTR (43-73%) remained relatively stable, with CTR performed in 60% of patients overall. Management pathway distributions, non-surgical only (27%), surgical only (13%), both (47%), or no treatment (13%), did not differ significantly across years (p >0.05). Among patients receiving injections, 70% reported symptom improvement, while postoperative CTR cure rate was found to be 95%. CTR follow-up was completed in 73% of surgical patients. Median time from diagnosis to injection was 289 days, from diagnosis to CTR was 143 days, and from surgery to follow-up was 13 days, with no significant temporal differences (p>0.05). Conclusions: CTS management patterns at the Carle Health System have remained consistent from 2019-2024, with high rates of surgical success and variable time to intervention. Although sample size and documentation variability were limiting factors, these finding provide a baseline characterization of local practice and highlight opportunities to improve referral efficiency and postoperative follow-up. Larger studies are needed to better define the progression of CTS care trends.