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Time to return to work after carpal tunnel release is extremely variable suggesting that only a small proportion of total sick-leave is for medical reasons.To determine factors predicting a delayed return to work.Fifty consecutive employed patients undergoing carpal tunnel surgery were tested pre-operatively, and then at 1 month post-operatively using both questionnaires and objective testing. Further follow-up by telephone was carried out every 2 weeks up until 90 days.Forty-nine of the 50 workers had returned to work by 3 months. Time to return to work was extremely variable ranging from 1 to 88 days in those who returned to work. Post-operative recommendations by the surgeon also varied widely from 1 to 36 days. The surgeons' recommendations were the strongest predictors of delayed return to work [odds ratio 30.5; 95% confidence interval (CI), 3.2–288], with physical work (odds ratio 27.7; 95% CI, 1.5–507) and lack of self-rated health (odds ratio 5.0; 95% CI, 1.11–100) adding significantly to the logistic regression model, which was highly predictive (area under the receiver–operator curve of 88%). Patient symptoms and objective findings of disability did not add significantly to a logistic regression model either predicting return to work or the surgeon's recommendations.Our study suggests that workers will return to work in less than 3 weeks if recommended by the surgeon. A randomized controlled trial is warranted to determine if a higher proportion of workers returning in less than 3 weeks can be obtained by standardizing surgeons' recommendations.