Epineurotomy of the median nerve in carpal tunnel release: a systematic review and an attempt of metanalysis

The role of epineurolysis in carpal tunnel release is not clear, and its inclusion or not in the standard practice is a subjective choice of the hand surgeon based on their training and experience rather than being based on evidence. A systematic review with metanalysis of randomized controlled trials comparing median nerve decompression at the carpal tunnel with or without the adjunct of epineurolysis was attempted, in order to define whether or not this is an effective procedure. From the metanalysis of the general postoperative outcome, no advantage seems to derive from epineurolysis. On the contrary, if the Tinel's sign is used for the equivalent analysis, an impression favoring epineurolysis is obtained. However, a definitive answer to the utility or not of this procedure can only be achieved through large and accurate randomized prospective controlled studies, possibly including a subdivision of patients into groups based on comorbidities.