Combined Manual Therapy and Percutaneous Neuromodulation for Moderate Carpal Tunnel Syndrome

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.

Inclusion Criteria: * 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. Exclusion Criteria: * 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. * Diabetes mellitus or other systemic diseases associated with peripheral neuropathy. * Cervical radiculopathy or other neurological disorders affecting the upper limb. * Rheumatoid arthritis or other inflammatory arthropathies involving the wrist. * Previous corticosteroid injection for carpal tunnel syndrome within the last 3 months. * Contraindications to percutaneous neuromodulation (e.g., pacemaker, active infection at the treatment site, bleeding disorders, or anticoagulant therapy when considered clinically inappropriate). * Inability to comply with the study protocol or follow-up assessments.