Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome: Revision 2026

This 2026 revision, from APTA Orthopedics and APTA Hand and Upper Extremity, updates the 2019 carpal tunnel syndrome guideline for physical therapists, covering diagnosis, outcome measures and nonsurgical treatment.

For diagnosis it recommends a hand symptom diagram, the Phalen, Tinel and carpal compression tests, monofilament and two-point discrimination testing, and the CTS-6 tool. It recommends tracking change with the Boston Carpal Tunnel Questionnaire and the DASH or QuickDASH, and advises against using pinch strength, or grip strength in the first 3 months after surgery, to measure progress.

For mild to moderate cases managed without surgery, the main recommendation is a wrist orthosis that holds the wrist near neutral, worn at night. Lower-grade options include manual therapy to the neck and arm, instrument-assisted soft-tissue work, stretching with an orthosis, kinesiology taping, laser, radial shockwave, interferential current, superficial heat, diathermy and ergonomic advice. It recommends against magnets and against corticosteroid iontophoresis or phonophoresis. Evidence on dry needling was not enough for a recommendation.