Effectiveness of Manual Therapy versus Surgery in Carpal Tunnel Syndrome: A Systematic Analysis of Recent Studies

Introduction: Carpal Tunnel Syndrome (CTS) is a common condition caused by median nerve compression, leading to pain, tingling, and functional impairment. Treatment options include manual physiotherapy and surgery, but the long-term effectiveness of conservative approaches remains under debate. To compare the effectiveness of manual physiotherapy and surgical treatment in managing CTS, focusing on pain relief, function, and quality of life. Methodology: This systematic review and meta-analysis (PROSPERO ID: CRD420251084593) included randomized controlled trials and observational studies (2015–2025) comparing manual physiotherapy and surgery. Primary outcomes included pain (VAS/NPRS), function (BCTQ/DASH), and patient-reported improvement (GROC). Results: Three high-quality studies with 317 patients were analyzed. Manual physiotherapy showed greater improvements in pain and function at 1 and 3 months, while both treatments had similar outcomes at 6, 12 months, and 4 years. No serious adverse events were reported in either group. Discussion: Manual therapy is as effective as surgery in the long term and may offer faster short-term recovery with fewer risks and lower costs. It is recommended as a first-line treatment in mild to moderate cases. However, more diverse and blinded studies are needed to confirm these findings. Conclusion: Manual physiotherapy is a safe, effective, and non-invasive alternative to surgery for CTS, particularly in less severe cases.