Manual Physical Therapies for Carpal Tunnel Syndrome: A Narrative Review of Mechanisms, Techniques, and Evidence

Abstract

Carpal Tunnel Syndrome (CTS) is the conventional entrapment neuropathy, influencing millions worldwide and giving rise to pain, paresthesia, and functional impairment. Manual physical therapy has secured acknowledgement as an effective non-invasive approach. This scientific review provides a thorough review of key Manual Therapy (MT) techniques, counting soft- tissue mobilization (myofascial release, massage), carpal bone and wrist joint mobilizations, median nerve neurodynamic gliding, and proximal cervical/thoracic outlet interventions, further with standard procedures (8–12 sessions over 4–8 weeks, often combined with splinting and home exercises). A combination of systematic reviews and network meta-analyses exhibits moderate-to-large short-term advancement in pain severity and Boston Carpal Tunnel Questionnaire scores, with progression in nerve conduction studies. MT frequently ranks highest among non-invasive therapies for pain relief and outperforms splinting or exercise alone, while obtaining outcomes equivalent to surgery in medium- and long-term follow-up with fewer complications and lower costs. Intended procedures include biomechanical relief of the carpal tunnel, enhanced nerve excursion, neurophysiological modulation via dropping inhibitory pathways, and contextual effects. MT is optimal as a frontline intervention for mild-to-moderate CTS. Despite these facts, limitations include clinical diversity and short follow-up in many trials; current evidence strongly supports its combination into clinical pathways. Future research should focus on standardized protocols, long-term consequences, subgroup analyses, and cost-effectiveness studies to process patient selection and optimize dosing.