• Ali Börekci, Özge Selahi, Nursena Tanriverdi, Mahmoud Osama, Halit Abbas Batırel, Kumsal Bihter Kontaytekin, Gürkan Berikol, Erhan Çelikoğlu, Emel Ece Özcan-Ekşi, and Murat Şakir Ekşi.
• FSM Training and Research Hospital, Neurosurgery Clinic, Istanbul, Turkey.
• World Neurosurg. 2023 Feb 1; 170: e402e415e402-e415.

BackgroundCarpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression of the median nerve throughout the carpal tunnel. It is the most common entrapment neuropathy, with an estimated prevalence of 4%-7%. Surgical management is more effective in moderate to severe and severe CTS. CTS recurs in approximately 20% of patients, and up to 12% of these patients require reoperation. Knowledge of normal anatomy and variations would improve the success rate of the index surgery. Atypical causes of CTS were reported, including ganglion cysts, synovial hypertrophy, lipomas, bone fracture, bone fragments, tumor of soft tissues or bones, neurofibromas, neuromas, vascular malformations, and accessory muscles. Accessory muscles are commonly detected in upper limbs. However, their concomitant presentation with CTS has rarely been reported. We aimed to present different accessory muscles diagnosed during CTS surgery through a systematic review of the literature with our exemplary case.MethodsA systematic review/meta-analysis was performed concomitant with a case presentation.ResultsAccessory muscles associated with CTS were as follows: palmaris longus, 28.6%; lumbrical muscles, 19.3%; palmaris profundus, 17.8%; flexor digitorum superficialis, 16.1%; transverse carpal muscle, 5%; flexor digitorum indicis, 4.2%; flexor superficialis indicis, 4.2%; flexor sublimis, 0.8%; accessory superficialis longus, 0.8%; flexor pollicis longus, 0.8%; abductor digiti minimi, 0.8%; abductor digiti quinti, 0.8%; and flexor digitorum superficialis brevis, 0.8%. Accessory muscles were mostly noticed during CTS surgery (88.2%).ConclusionsKnowledge of possible variations within the carpal tunnel would improve the surgeon's capability during CTS surgery.Copyright © 2022 Elsevier Inc. All rights reserved.

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