Modern Non‑Surgical Management of Carpal Tunnel Syndrome: Mechanisms, Clinical Evidence and Therapeutic Potential: A Literature Review

Abstract

Background: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy and represents a major functional and socioeconomic burden. Although surgical decompression remains the gold standard for advanced disease, current guidelines emphasize non-invasive management in mild‑to‑moderate CTS. This has stimulated rapid development of novel therapeutic strategies aimed at reducing median nerve compression, modulating inflammation, and supporting neural regeneration.

Aim of the study: To provide a comprehensive review of contemporary non-surgical methods used in CTS treatment, including extracorporeal shock wave therapy (ESWT), low‑level laser therapy (LLLT), ultrasound-based interventions, as well as platelet-rich plasma (PRP) injections, and to assess their mechanisms, clinical efficacy and potential therapeutic relevance.

Methodology: The review was conducted using PubMed, Google Scholar and Research Gate databases, focusing  on peer-reviewed literature published between 2021 and 2026.

Results: The study shows that ESWT provides only short‑term symptom relief, while the clinical effects of LLLT remain inconsistent due to variable treatment parameters. Among all evaluated methods, PRP demonstrates the most substantial therapeutic and regenerative potential, yielding marked, lasting improvements in symptom severity and nerve conduction that surpass those achieved with corticosteroid injections.

Conclusions: Modern conservative interventions differ considerably in effectiveness and mechanisms of action. While ESWT and LLLT may serve as supportive therapies, ultrasound-based methods-particularly USG‑guided techniques-and PRP injections display superior therapeutic value. Despite encouraging results, further high‑quality, long‑term randomized trials are needed to standardize treatment protocols and confirm the comparative effectiveness of these methods.