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Volume 16
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Background:
Systematic Review

Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials

by
Sara Masiero
1,
Pasquale Arcuri
2,
Paolo Boccolari
3,
Elena Zorzi
4,
Alessandro Vio
5,
Tracy Fairplay
2,
Davide Zanin
6,
Fabio Vita
7,
Danilo Donati
3,8 and
Roberto Tedeschi
9,*
1
MediClinic, 35020 Pozzonovo, Italy
2
Fairplay-Arcuri Private Functional Hand Rehabilitation, 40100 Bologna, Italy
3
Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy
4
Azienda ULSS 6 Euganea, U.O.C. Medicina Fisica e Riabilitazione, Ospedale Camposampiero, 35020 Padova, Italy
5
Independent Researcher and Clinician, inFisio, 47893 Borgo Maggiore, San Marino
6
Independent Resercher, 10121 Torino, Italy
7
IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
8
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
9
Independent Researcher, 40100 Bologna, Italy
*
Author to whom correspondence should be addressed.
Brain Sci. 2026, 16(4), 399; https://doi.org/10.3390/brainsci16040399
Submission received: 5 March 2026 / Revised: 30 March 2026 / Accepted: 1 April 2026 / Published: 8 April 2026
(This article belongs to the Section Neurosurgery and Neuroanatomy)
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Abstract

Background: Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies. While surgical decompression is widely considered the definitive treatment, conservative options remain clinically relevant, particularly for symptom relief and functional recovery in the short term. Objectives: To update the evidence comparing surgical versus non-surgical interventions for CTS, assessing pain, function, and clinical recovery. Design: Systematic review of randomised controlled trials (RCTs). Data Sources and Methods: Six databases (CENTRAL, MEDLINE, Embase, Cochrane Neuromuscular Register, ClinicalTrials.gov, and WHO ICTRP) were searched for RCTs published between November 2022 and January 2025. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Due to clinical heterogeneity, a narrative synthesis was performed. Results: Four RCTs (n = 1158) were included. Corticosteroid injection and percutaneous electrical nerve stimulation (PENS) appeared to provide faster symptom relief than surgery at short-term follow-up. However, surgery was associated with a higher probability of sustained recovery at 12–18 months (RR 1.36; 95% CI 1.19–1.56). Evidence for PENS was limited to one female-only trial, which restricts generalisability. Certainty of evidence was moderate for long-term outcomes and low for short-term results and safety. Conclusions: The available evidence suggests that surgery may offer more durable long-term recovery, whereas corticosteroids and PENS may be useful for short-term symptom relief. These findings should be interpreted with caution given the limited number of trials and the risk of bias in most included studies. Treatment choice should align with patient goals and recovery timelines. Registration: PROSPERO (CRD420250650789).
Keywords: carpal tunnel syndrome; surgical versus conservative management; evidence-based rehabilitation; nerve decompression; functional recovery carpal tunnel syndrome; surgical versus conservative management; evidence-based rehabilitation; nerve decompression; functional recovery

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MDPI and ACS Style

Masiero, S.; Arcuri, P.; Boccolari, P.; Zorzi, E.; Vio, A.; Fairplay, T.; Zanin, D.; Vita, F.; Donati, D.; Tedeschi, R. Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials. Brain Sci. 2026, 16, 399. https://doi.org/10.3390/brainsci16040399

AMA Style

Masiero S, Arcuri P, Boccolari P, Zorzi E, Vio A, Fairplay T, Zanin D, Vita F, Donati D, Tedeschi R. Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials. Brain Sciences. 2026; 16(4):399. https://doi.org/10.3390/brainsci16040399

Chicago/Turabian Style

Masiero, Sara, Pasquale Arcuri, Paolo Boccolari, Elena Zorzi, Alessandro Vio, Tracy Fairplay, Davide Zanin, Fabio Vita, Danilo Donati, and Roberto Tedeschi. 2026. "Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials" Brain Sciences 16, no. 4: 399. https://doi.org/10.3390/brainsci16040399

APA Style

Masiero, S., Arcuri, P., Boccolari, P., Zorzi, E., Vio, A., Fairplay, T., Zanin, D., Vita, F., Donati, D., & Tedeschi, R. (2026). Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials. Brain Sciences, 16(4), 399. https://doi.org/10.3390/brainsci16040399

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