Changes in Sleep, Fatigue, Kinesiophobia, and Upper Extremity Function After Carpal Tunnel Release

Prospective Longitudinal Evaluation of Changes in Sleep Quality, Fatigue, Kinesiophobia, Pain, and Upper Extremity Function After Carpal Tunnel Release Surgery

Carpal tunnel syndrome can cause hand pain, numbness, weakness, sleep disturbance, fatigue, fear of movement, and difficulty performing daily activities. Carpal tunnel release surgery is commonly performed when symptoms are severe or do not improve with conservative treatment. However, recovery after surgery may involve changes not only in hand symptoms but also in sleep, fatigue, fear of movement, pain, and upper extremity function.

The aim of this prospective observational study is to evaluate how sleep quality, fatigue, kinesiophobia, pain, carpal tunnel syndrome-related symptoms, and upper extremity function change after carpal tunnel release surgery.

Adults scheduled for unilateral primary carpal tunnel release surgery as part of their routine clinical care will be invited to participate. The researchers will not assign or modify the surgical procedure, medication, rehabilitation, or other clinical treatment. Participants will be evaluated before surgery and at 4 and 8 weeks after surgery.

Sleep quality will be assessed using the Pittsburgh Sleep Quality Index. Fatigue, kinesiophobia, upper extremity function, carpal tunnel syndrome-related symptoms, and pain will be assessed using the Fatigue Severity Scale, Tampa Scale of Kinesiophobia, QuickDASH, Boston Carpal Tunnel Questionnaire, and Numeric Rating Scale, respectively.

The study will examine changes in these outcomes over time and investigate whether improvements in sleep and fatigue are associated with reductions in pain, kinesiophobia, and carpal tunnel syndrome symptoms and with improvements in upper extremity function.

Carpal tunnel syndrome is a common peripheral entrapment neuropathy caused by compression of the median nerve at the wrist. It may lead to pain, numbness, paresthesia, hand weakness, sleep disturbance, and limitations in upper extremity function. Night-time symptoms are particularly common and may cause frequent awakenings and impaired sleep quality. Patients may also experience fatigue and fear of movement, which can negatively affect the use of the operated hand and participation in daily activities.

Carpal tunnel release surgery is routinely performed in patients with severe median nerve compression or persistent symptoms despite conservative treatment. Although surgical outcomes are commonly evaluated using pain, sensory symptoms, nerve conduction findings, and hand function, these measures may not fully reflect the broader patient-centered recovery process. A longitudinal assessment of sleep quality, fatigue, kinesiophobia, pain, disease-specific symptoms, and upper extremity function may provide a more comprehensive understanding of recovery after surgery.

This study is designed as a prospective, observational, longitudinal cohort study. Adults diagnosed with carpal tunnel syndrome through clinical and electrophysiological evaluation and scheduled for unilateral primary carpal tunnel release surgery will be recruited consecutively from Medipol Hospitals in Istanbul, Türkiye.

The decision to perform surgery and the choice of surgical technique will be made by the treating physician as part of routine clinical care and independently of study participation. The investigators will not assign, modify, or restrict the surgical procedure, medication, postoperative rehabilitation, physiotherapy, or other clinical treatments. Therefore, the study does not include an experimental intervention.

Participants will be evaluated at three time points:

T0: Within 1 week before carpal tunnel release surgery.

T1: Postoperative Week 4, with an allowable window of plus or minus 7 days.

T2: Postoperative Week 8, with an allowable window of plus or minus 7 days.

At each assessment, the following patient-reported outcome measures will be administered:

1. Pittsburgh Sleep Quality Index to assess sleep quality.
2. Fatigue Severity Scale to assess the severity and functional impact of fatigue.
3. Tampa Scale of Kinesiophobia to assess fear of movement or reinjury.
4. QuickDASH to assess symptoms and upper extremity functional limitations.
5. Boston Carpal Tunnel Questionnaire, including the Symptom Severity Scale and Functional Status Scale, to assess carpal tunnel syndrome-specific outcomes.
6. Numeric Rating Scale to assess pain at rest, during activity, and at night.

Demographic and clinical information will include age, sex, body mass index, educational and occupational status, hand dominance, operated side, symptom duration, unilateral or bilateral carpal tunnel syndrome, electrophysiological severity, previous conservative treatments, comorbidities, medication use, smoking status, surgical technique, postoperative complications, and postoperative physiotherapy or rehabilitation.

The primary objective is to determine the change in sleep quality from the preoperative assessment to 4 and 8 weeks after surgery. Secondary objectives are to evaluate changes in fatigue, kinesiophobia, pain, carpal tunnel syndrome-specific symptoms, and upper extremity function and to investigate the relationships among changes in these outcomes. The study will also explore demographic and clinical factors associated with postoperative functional improvement.

Repeated measurements will be evaluated using longitudinal statistical methods. Linear mixed-effects models are planned for the primary analyses, with time included as a fixed effect and participant included as a random effect. Associations among outcome measures will be examined using correlation analyses, and potential predictors of postoperative functional improvement may be evaluated using multivariable regression models. Effect estimates and 95% confidence intervals will be reported.

Inclusion Criteria:

• Adults aged 18 to 70 years.
• Clinical and electrophysiological diagnosis of carpal tunnel syndrome.
• Scheduled to undergo unilateral primary carpal tunnel release surgery as part of routine clinical care.
• Ability to read and understand Turkish.
• Sufficient cognitive ability to understand and complete the study questionnaires.
• Willingness to participate and provision of written informed consent.
• Ability and willingness to complete the preoperative and postoperative follow-up assessments.

For participants with bilateral carpal tunnel syndrome, only the surgically treated hand will be designated as the index hand and included in the study assessments.

Exclusion Criteria:

• Previous carpal tunnel release surgery on the index hand.
• Scheduled revision carpal tunnel surgery.
• Simultaneous bilateral carpal tunnel release surgery.
• Concomitant severe cervical radiculopathy, brachial plexus lesion, ulnar neuropathy, radial neuropathy, or another neurological or orthopedic condition that substantially affects upper extremity function.
• Severe rheumatologic or neurodegenerative disease affecting upper extremity function.
• Cognitive impairment or severe psychiatric illness that prevents understanding or completion of the study assessments.
• Uncontrolled systemic disease that may interfere with participation or follow-up.
• New trauma or additional surgery affecting the same upper extremity during the follow-up period.
• Inability to complete the planned follow-up assessments.
• Refusal or withdrawal of informed consent.