Neural Recovery After Carpal Tunnel Release: A Systematic Review With Meta-Analysis

Area of Science:

• Orthopedics and Sports Physical Therapy
• Neurology
• Regenerative Medicine

Background:

• Carpal tunnel syndrome (CTS) is a common condition affecting median nerve function.
• Surgical carpal tunnel release (CTR) aims to alleviate nerve compression.
• Understanding long-term nerve recovery post-CTR is crucial for patient management.

Purpose of the Study:

• To quantify structural and functional nerve changes after carpal tunnel release.
• To characterize median nerve recovery trajectories and regenerative capacity.
• To compare post-operative outcomes to healthy controls.

Main Methods:

• Systematic review and meta-analysis of prognostic studies.
• Searched six databases (inception-June 2024) for outcomes including electrodiagnostics, sensory testing, strength, and nerve fiber density.
• Included 199 studies (15,636 patients); analyzed data categorized by time post-surgery (<2, 2-4, 5-7, 8-12, >12 months).

Main Results:

• Significant, time-dependent improvements observed in most measured nerve parameters post-CTR.
• Grip and pinch strength recovery was delayed, becoming marked only at 5-7 months.
• Persistent deficits in electrodiagnostics and sensory thresholds (warm, vibration, mechanical) noted even 1 year post-surgery compared to controls.

Conclusions:

• Carpal tunnel release facilitates gradual median nerve functional and structural recovery.
• Key nerve function indicators, including electrodiagnostics and sensory perception, may not fully normalize even one year after surgery.
• The findings highlight the potential for persistent nerve deficits despite surgical intervention.