The Morphological Changes in The Median Nerve Following Carpal Tunnel Release: A Systematic Review and Meta-analysis
Shorouq Sakrana1, Merna Raafat Roshdy2, Rahma AbdElfattah Ibrahim3, Hany Atwan4
1Ain Shams University, Cairo, Egypt, 2Faculty of Medicine, Sohag University, Sohag, Egypt, 3Faculty of Medicine, KafrElsheikh University, KafrElsheikh, Egypt, 4Faculty of Medicine, Assiut University, Assiut, Egypt
Objective:

This review aims to evaluate these changes following CTR, addressing a significant gap in the existing literature.

Background:
Carpal tunnel syndrome (CTS) is a prevalent neuropathy affecting the upper limb, often treated with carpal tunnel release (CTR) in moderate to severe cases. Despite CTR's widespread use, the morphological changes in the median nerve—especially its cross-sectional area (CSA)—remain inadequately understood.
Design/Methods:

We conducted a systematic review following PRISMA and Cochrane Handbook guidelines, including randomized controlled trials and observational studies of CTS patients who underwent CTR. Studies were selected based on their use of ultrasonography, CT, or MRI to assess the median nerve. We focused on studies evaluating CSA changes at 3, 6, and 12 months postoperatively. Data extracted from multiple databases included study design, patient demographics, intervention types, and outcomes.

Results:

Our analysis encompassed 33 studies (5 cohort studies and 28 clinical trials) involving 1,000 patients with CTS (ages 24 to 90 years; 70% female). Significant changes in CSA were observed in proximal structures at 3 months (95% CI: 0.42 to 1.16, p < 0.0001), while no significant changes were noted in distal structures (95% CI: -0.71 to 0.28, p > 0.05). At 6 months, both proximal (95% CI: 0.60 to 1.15, p < 0.00001) and distal (95% CI: -4.25 to -0.34, p = 0.02) structures exhibited significant changes. By 12 months, neither structure showed significant alterations, indicating stability. Additionally, motor conduction was higher preoperatively than postoperatively, with increased motor latency observed after surgery.

Conclusions:

Carpal tunnel release remains the optimal treatment for severe CTS. Our findings provide a comprehensive overview of median nerve changes post-CTR, enhancing our understanding of the anatomical implications for recovery. Further research is warranted to explore the relationship between these changes and functional outcomes.

10.1212/WNL.0000000000211679
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