Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy and can cause pain, numbness, tingling, and functional impairment of the hand. Although surgical decompression is considered an effective treatment for moderate CTS, there is increasing interest in conservative therapeutic strategies that may improve symptoms and function while avoiding surgery.
The aim of this multicenter non-randomized controlled trial is to evaluate the effectiveness of a combined intervention consisting of manual therapy and ultrasound-guided percutaneous neuromodulation compared with conventional postsurgical rehabilitation in patients with moderate CTS.
Participants allocated to the experimental group will receive a standardized multimodal physiotherapy program including manual therapy techniques and ultrasound-guided percutaneous neuromodulation, whereas participants in the control group will undergo standard rehabilitation following carpal tunnel release surgery. The primary outcome will be symptom severity and functional status assessed with the Boston Carpal Tunnel Questionnaire. Secondary outcomes will include pain intensity, nerve conduction parameters, ultrasound measures, hand strength, patient-reported outcomes, and adverse events.
The findings of this study are expected to provide evidence regarding the potential role of combined conservative treatment as an alternative therapeutic strategy for patients with moderate carpal tunnel syndrome.
Adults aged 30 to 50 years.
Clinical diagnosis of moderate carpal tunnel syndrome confirmed by nerve conduction studies according to the American Association of Electrodiagnostic Medicine criteria.
Symptoms persisting for at least 3 months.
Ability to understand the study procedures and provide written informed consent.
Previous surgery for carpal tunnel syndrome in the affected hand (experimental group only).
Severe carpal tunnel syndrome requiring urgent surgical intervention.
History of wrist fracture or major upper-limb trauma affecting the study limb.
Pregnancy.
Parallel
Combined Manual Therapy and Ultrasound-Guided Percutaneous Neuromodulation
Procedure/SurgeryParticipants will receive a multimodal conservative treatment consisting of manual therapy and ultrasound-guided percutaneous neuromodulation. Manual therapy will include myofascial release, passive accessory joint mobilization, cervical mobilization when indicated, and median nerve neurodynamic mobilization. Ultrasound-guided percutaneous neuromodulation will be applied to the median nerve using low-frequency electrical stimulation according to a standardized protocol.
Postsurgical Rehabilitation
Other interventionParticipants will receive a standardized physiotherapy program following carpal tunnel release surgery, including transcutaneous electrical nerve stimulation (TENS), active and passive mobilization exercises, strengthening exercises, stretching, cryotherapy, and soft tissue techniques as clinically indicated.
Boston Carpal Tunnel Questionnaire (BCTQ) total score
The primary outcome is the change in symptom severity and functional status assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), a validated patient-reported outcome measure for carpal tunnel syndrome.
Pain intensity
Pain intensity assessed using the Visual Analogue Scale (VAS).
Upper-limb disability
Upper-limb disability assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
Median nerve sensory conduction velocity
Sensory conduction velocity (m/s) assessed by standardized nerve conduction studies.
Median nerve distal motor latency
Distal motor latency (ms) assessed by standardized nerve conduction studies.
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