Topographic Anatomy of the Recurrent Motor Branch of the Median Nerve

İntroduction: The recurrent motor branch (RMD) of the median nerve is a critical anatomical structure that is susceptible to injury during surgery. This study aims to provide surgical guidance to prevent RMD damage in carpal tunnel syndrome (CTS) surgery by detailing the topographic anatomy of the median nerve. Materials and Methods This study included 58 patients (59 hands) who underwent surgery for carpal tunnel syndrome between 2020 and 2022. All procedures were performed using an open incision technique, and the topographic anatomy of the RMD was mapped by measuring its distances from the first and third metacarpal heads and the radial styloid process. Additionally, the relationship between the motor branch and the transverse carpal ligament was evaluated according to the Lanz classification. Surgical success was assessed using the Boston Carpal Tunnel Questionnaire (BCTQ). Results The mean distance of the RMD from the first metacarpal head was 39.7 mm, from the third metacarpal head was 50.2 mm, and from the radial styloid process was 59.4 mm. According to the Lanz classification, 67% of patients had an extraligamentous course, 25% had a subligamentous course, and 8% had a transligamentous course. No cases of wound dehiscence, hematoma, or infection were observed postoperatively. BCTQ results demonstrated significant improvements in symptom severity and functional status following surgery. Conclusion Our study highlights the importance of using bony reference points to preserve the recurrent motor branch of the median nerve during surgery. Mapping the RMD can help surgeons minimize surgical complications.