Initial self-report assessments of symptom severity in patients with carpal tunnel syndrome was retrospectively examined. At initial evaluation, 86 patients completed a self-administered questionnaire previously shown to be reproducible, internally consistent, and responsive to clinical change. Within the next 2 years, 50 patients underwent carpal tunnel release; of the other 36 patients, 23 were managed adequately with conservative treatment alone, and 13 were lost to follow-up. Initial mean symptom severity scores were statistically significantly higher for the surgery group (P = .000012). Significantly higher symptom severity scores on self-administered questionnaires at initial evaluation from patients who eventually undergo carpal tunnel release may be of value in treatment planning.