Carpal tunnel syndrome (CTS) release is the most common upper extremity surgery, but is it more cost effective than just PT?

One study showed no difference in health care costs between CTS surgery versus CTS splinting therapy and each costing about €2000 or say $3000 (Korthals-de Bos et al 2006).

Another study showed no difference again in health care costs between those receiving CTS surgery versus local corticoid injections (mean =$4000) however the clinical outcome slightly favoured the surgery group (Pomerance et al 2009).

This 2019 RCT in Spain randomly allocated 120 women with CTS to either receive manual physical therapy (MPT) or decompression surgery.

The MPT involved 3 sessions over 3 weeks, including…

  • Soft tissue mobilizations of the forearm flexors and median nerve region
  • Cervical lateral glide mobilizations
  • Neural flossing home exercises
  • Nerve tendon gliding home exercises

Result #1: MPT was significantly less costly than surgery (about $3700 less per patient)

Result #2: Work absenteeism was significantly less in the MPT group than the surgery group (65 days versus 28 days off)

Result #3: Patients in the MPT group had significantly less visits to medical doctors

Conclusion: Manual physical therapy, focusing on soft tissue release and neural mobilizations and home program, appears to be equally effective but more cost-effective than surgery for CTS.

The 3 basic CTS interventions I suggest are…

Tissue distraction release (TDR) with movement of the forearm flexors, extensors & carpal tunnel region (See videos in APTEI Library)

Nerve flossing exercise such as “free the bird”

Nerve tendon gliding exercises with a rubber band (See videos in APTEI Library)

If a patient does not respond to 8 weeks of MPT, either cortisone or surgery may be suggested.


Reference: Fernández-de-Las-Peñas C, et al Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial. Orthop Sports Phys Ther. 2019 Feb;49(2):55-63.

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