The goal of this clinical trial is to compare two physical therapy treatments in people with mild-to-moderate carpal tunnel syndrome (CTS). CTS is a condition that causes pain, numbness, and weakness in the hand.

The main question this study aims to answer is:

Does pulsed ultrasound or pulsed shortwave diathermy lead to greater improvement in symptoms and nerve swelling when added to standard treatment?

All participants will receive standard conservative treatment, including a wrist splint and nerve and tendon gliding exercises for three weeks. In addition, participants will be randomly assigned to receive one of the following treatments:

Pulsed therapeutic ultrasound (US) Pulsed shortwave diathermy (SWD) Researchers will measure changes in hand symptoms, pain levels, grip strength, and the size of the median nerve using ultrasound imaging. Assessments will be performed before treatment, and at 1 month and 3 months after treatment.

The primary outcome of the study is the change in median nerve cross-sectional area at 3 months.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity and is characterized by pain, numbness, and hand weakness. Conservative treatment is recommended as first-line therapy in patients with mild-to-moderate CTS and commonly includes wrist splinting and nerve and tendon gliding exercises. Physical therapy modalities are frequently added to improve clinical outcomes.

This randomized, assessor-blinded, parallel-group clinical trial was conducted between March 2025 and Sep 2025. Forty participants with electrophysiologically confirmed mild-to-moderate CTS were randomly assigned to one of two intervention groups. All participants received standard conservative treatment consisting of neutral-position wrist splinting and tendon-nerve gliding exercises for three weeks.

In addition to standard treatment, one group received pulsed therapeutic ultrasound (US) and the other group received pulsed shortwave diathermy (SWD), administered in 15 sessions over three weeks.

Outcome measures were assessed at baseline, 1 month, and 3 months. The primary outcome was the change in median nerve cross-sectional area measured by ultrasonography at 3 months. Secondary outcomes included symptom severity and functional status assessed by the Boston Carpal Tunnel Questionnaire (BCTQ), pain intensity measured by the Visual Analog Scale (VAS), neuropathic pain assessed using the DN4 questionnaire, and hand grip strength measured with a dynamometer.

The study was designed to compare the clinical and structural effects of pulsed US and pulsed SWD when added to standard conservative treatment in mild-to-moderate CTS.

Inclusion Criteria:

• Age between 18 and 65 years
• Symptom duration of at least 4 weeks
• Diagnosis of mild-to-moderate carpal tunnel syndrome confirmed by electromyography

Exclusion Criteria:

• Cervical radiculopathy
• Brachial plexopathy
• Thoracic outlet syndrome
• Previous carpal tunnel surgery
• Severe carpal tunnel syndrome
• Pregnancy
• Malignancy
• Coagulation disorders
• Cardiac pacemaker
• Physical therapy for carpal tunnel syndrome within the previous 6 months

Individual participant data will not be shared due to institutional data protection policies and privacy considerations.

Outcome assessments, including ultrasonographic measurements and clinical questionnaires, were performed by an assessor blinded to group allocation. Participants and treatment providers were not blinded due to the nature of the interventions.