Ultrasonographical Evaluation of the Median Nerve Mobility in Carpal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Abstract

Diagnostic ultrasound is widely used for evaluating carpal tunnel syndrome (CTS), an entrapment neuropathy of the median nerve (MN). Decreased mobility of the MN inside the carpal tunnel has been reported in CTS, and various methods have been used to evaluate MN mobility; however, there is still no conclusive understanding of its connection with CTS. The purpose of this study is to conduct a systematic review and meta-analysis of the current published literature on ultrasonographic evaluations of transverse and longitudinal MN displacement and to identify the relationship between MN mobility and CTS. This study was conducted in accordance with the 2020 PRISMA statement and the Cochrane Collaboration Handbook. Comparative studies that investigated differences in MN displacement between CTS patients and healthy controls were retrieved by searching the Cochrane Library, Embase and PubMed. A total of 15 case–control studies were included. Nine of 12 studies evaluating transverse MN displacement and 4 of 5 studies evaluating longitudinal MN gliding showed that the MN was less mobile in CTS patients than in healthy subjects. Despite the large heterogeneity among the 15 included studies, this systematic review and meta-analysis provide evidence that the mobility of the MN is significantly reduced in both transverse and longitudinal planes in CTS patients compared to healthy controls. Five of the 15 included studies reported that a decrease in transverse or longitudinal MN displacement in CTS was correlated with clinical symptoms or with severity as measured by a nerve conduction study (NCS).