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

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.

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.

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.