Comparative Effects of Manual Therapy and Nerve Mobilization versus Splinting versus Corticosteroid Injection on Pain Intensity, Symptom Severity, Functional Status, Grip Strength, Pinch Strength, Median Nerve Cross-Sectional Area, and Nerve Conduction Parameters in Patients with Mild-to-Moderate Carpal Tunnel Syndrome

Background: Carpal tunnel syndrome (CTS) represents the most common peripheral nerve compression disorder, with multiple conservative treatment options available. Comparative effectiveness data regarding manual therapy combined with nerve mobilization (MTNM), static splinting (SS), and corticosteroid injection (CSI) remain limited.
Objective: To compare the comparative effectiveness of MTNM, SS, and CSI on clinical and neurophysiological outcomes in patients with mild-to-moderate CTS.
Methods: This parallel-design, randomized controlled trial enrolled 120 participants (aged 25-65 years) with electrodiagnostically confirmed mild-to-moderate CTS. Participants were randomly assigned to MTNM (n=40, 10 sessions over 5 weeks), SS (continuous for 4 weeks, then nocturnal for 4 weeks), or CSI (single ultrasound-guided injection). Primary outcomes were pain intensity (Visual Analog Scale [VAS]) and symptom severity (Boston Carpal Tunnel Questionnaire [BCTQ]). Assessments occurred at baseline, 4, 8, and 12 weeks.
Results: All interventions demonstrated significant within-group improvements (p<0.001). MTNM demonstrated superior sustained functional improvements (DASH scores at 12 weeks: MTNM 16.5±8.2, CSI 22.3±9.1, SS 31.2±10.4, p<0.001). MTNM produced the greatest median nerve cross-sectional area reduction (1.5±0.6 mm² vs CSI 1.2±0.5 mm² vs SS 0.8±0.4 mm², p<0.001). Median nerve conduction velocity improvements were significantly greater in MTNM (6.2±2.1 m/s) and CSI (5.4±2.3 m/s) compared to SS (1.9±1.8 m/s, p<0.001).
Conclusion: Manual therapy combined with nerve mobilization demonstrates superior long-term functional outcomes and structural nerve improvements compared to splinting and corticosteroid injection in mild-to-moderate CTS. MTNM should be considered a preferred first-line conservative intervention.

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