Related Experiment Video
Updated: Jan 10, 2026
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Neuroanatomic Changes in the Median Nerve After Surgical Release in Moderate-to-Severe Carpal Tunnel Syndrome
José Antonio Expósito-Tirado1, José María Delgado-Mendilivar2, Jorge Angulo-Gutiérrez3
1Department of Physical Medicine and Rehabilitation, Virgen del Rocío University Hospital, Avenida Manuel Siurot S/N, 41013, Seville, Spain; Department of Physical Medicine and Rehabilitation, Virgen de Valme University Hospital, Seville, Spain.
Objective:
To primarily assess neuroanatomic changes after carpal tunnel syndrome (CTS) surgical release and their association with patient symptoms and functional status; secondarily, to determine the optimal timepoint for evaluating therapeutic outcomes.
Design:
Prospective quasi-experimental study with a follow-up period of 6 months.
Setting:
Physical medicine and rehabilitation institutional practice in an outpatient setting.
Participants:
A total of 34 patients (N=34) diagnosed with moderate-to-severe CTS by ultrasound, who underwent surgical release between May 2022 and July 2023.
Interventions:
Median nerve surgical release.
Main Outcome Measures:
Ultrasound was used to assess the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve before surgery and at 15 days, 3 months, and 6 months postoperatively. The Boston Carpal Tunnel Syndrome Questionnaire was administered to assess symptom severity and functional status.
Results:
Of the participants, 73.6% were women, with a median age of 48.8 years (42.5-53.3). Before surgery, CSA at the carpal tunnel inlet measured 14.3 mm² (interquartile range, 13-17) and at the outlet 10 mm² (interquartile range, 9-11); the FR was 3.1 (2.5-3.7). The CSA at the inlet was the only parameter to show consistent improvement at all follow-up points: 15 days (P=.001), 3 months (P<.001), and 6 months (P<.001). The Boston Carpal Tunnel Syndrome Questionnaire scores for symptom severity and functional status showed significant reduction at 3 and 6 months (P<.001).
Conclusions:
A reduction in the elevated CSA of the median nerve was observed after CTS surgical release, with the optimal evaluation point being 3 months postoperatively. This anatomic improvement was associated with decreased symptom severity and improved functional status.
