{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T16:47:24Z","timestamp":1775666844463,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>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\u201318 months (RR 1.36; 95% CI 1.19\u20131.56). 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).<\/jats:p>","DOI":"10.3390\/brainsci16040399","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:26:39Z","timestamp":1775661999000},"page":"399","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials"],"prefix":"10.3390","volume":"16","author":[{"given":"Sara","family":"Masiero","sequence":"first","affiliation":[{"name":"MediClinic, 35020 Pozzonovo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9137-4187","authenticated-orcid":false,"given":"Pasquale","family":"Arcuri","sequence":"additional","affiliation":[{"name":"Fairplay-Arcuri Private Functional Hand Rehabilitation, 40100 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Boccolari","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Zorzi","sequence":"additional","affiliation":[{"name":"Azienda ULSS 6 Euganea, U.O.C. Medicina Fisica e Riabilitazione, Ospedale Camposampiero, 35020 Padova, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5285-3513","authenticated-orcid":false,"given":"Alessandro","family":"Vio","sequence":"additional","affiliation":[{"name":"Independent Researcher and Clinician, inFisio, 47893 Borgo Maggiore, San Marino"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tracy","family":"Fairplay","sequence":"additional","affiliation":[{"name":"Fairplay-Arcuri Private Functional Hand Rehabilitation, 40100 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Zanin","sequence":"additional","affiliation":[{"name":"Independent Resercher, 10121 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Vita","sequence":"additional","affiliation":[{"name":"IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4301-7569","authenticated-orcid":false,"given":"Danilo","family":"Donati","sequence":"additional","affiliation":[{"name":"Physical Therapy and Rehabilitation Unit, Policlinico di Modena, 41125 Modena, Italy"},{"name":"Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9037-4767","authenticated-orcid":false,"given":"Roberto","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Independent Researcher, 40100 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S1474-4422(22)00432-X","article-title":"Carpal Tunnel Syndrome: Updated Evidence and New Questions","volume":"22","author":"Padua","year":"2023","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/J.JHSB.2006.12.010","article-title":"The First Description of Carpal Tunnel Syndrome","volume":"32","author":"Paget","year":"2007","journal-title":"J. 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Pain"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/4\/399\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T15:51:01Z","timestamp":1775663461000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/16\/4\/399"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":37,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["brainsci16040399"],"URL":"https:\/\/doi.org\/10.3390\/brainsci16040399","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]}}}