Inflammation in Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis of the Immune Profile

Objectives: This systematic review and meta-analysis aimed to assess whether serum inflammatory markers are associated with Carpal Tunnel Syndrome (CTS), moving beyond the traditional mechanical explanation. Methods: Seven observational studies involving a total of 609 adult participants (CTS patients and matched healthy controls) were included. Studies were selected through comprehensive searches of PubMed and Embase databases up to April 2025. Data extraction and quality assessment were independently performed by two reviewers using the Newcastle-Ottawa Scale. Standardized mean differences (SMDs) and 95% confidence intervals were calculated using random-effects meta-analysis. Results: CTS patients exhibited significantly elevated serum levels of CCL2, CCL5, CXCL10, CXCL8, IL-4, VEGF, and TGF-β compared to controls. CCL4 was increased in the fixed-effect model but showed high heterogeneity; however, it was not statistically significant in the random-effects model and demonstrated extreme heterogeneity. No significant or consistent differences were observed for IL-1β, IL-6, IL-9, IL-10, TNF-α, or IFN-α. Conclusions: CTS is associated with a systemic pro-inflammatory and pro-fibrotic profile. CCL2, CCL5, IL-4, VEGF, and TGF-β may serve as promising biomarkers. Further large-scale, standardized studies are needed to validate these findings.