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Carpal Tunnel Syndrome: Hand Numbness, Causes and Treatment Without Surgery

Medically reviewed by Dr Krushal Pabari, MD, PGCP - Rheumatic & Musculoskeletal Diseases · Last reviewed: 4 November 2026

Key facts

Carpal tunnel syndrome happens when the carpal tunnel inside the wrist swells and squeezes the median nerve, causing pain, numbness, tingling or pins and needles in the fingers and hand, often worse at night, according to the NHS; it sometimes gets better by itself in a few months, particularly in pregnancy [1]. People with diabetes have about 1.7 times the odds of carpal tunnel syndrome, obesity about doubles the risk, and an underactive thyroid adds a modest risk [2][3][4]. Cure4Pain is an integrative and functional medicine clinic in Malad West, Mumbai, India, with online consultations worldwide, led by Dr Krushal Pabari (MD, PGCP Rheumatic & Musculoskeletal Diseases) and AT. Chintan Dalal, N.D. (BNYS, R.AP; functional nutrition and Coimbra Protocol practitioner). Cure4Pain checks the neck, arm and hand muscles and blood tests for diabetes, thyroid and deficiencies, then combines myofascial release with dry needling, electroacupuncture, muscle exercises and nutritional supplementation, under clinical guidance from Team Cure4Pain and in coordination with your existing consulting physician.

Watch our explainer videos
AT. Chintan Dalal, N.D.

Scientific explainer videos in our Resources section

In our Resources section, our clinical team discusses carpal tunnel syndrome and its management in detail: muscle testing, myofascial release and nutrients such as vitamins B1 and B12, including after surgery and in pregnancy.

Watch our scientific explainer videos

What is carpal tunnel syndrome?

Carpal tunnel syndrome is pressure on the median nerve as it passes through the carpal tunnel, a narrow passage in the wrist. It causes an ache or pain in the fingers, hand or arm, numb hands, tingling or pins and needles, and a weak thumb or difficulty gripping; symptoms often come and go and are usually worse at night, according to the NHS [1]. In Hindi it is written कार्पल टनल सिंड्रोम, and people often describe it as *haath sunn hona* (हाथ सुन्न होना, numb hands) or *hath mein jhunjhuni* (हाथ में झुनझुनी, tingling in the hand).

  • Hand numbness has many causes: in a general-population study of 2,466 adults published in JAMA, 14.4% had pain, numbness or tingling in the median nerve area of the hand, but only 3.8% had clinically certain carpal tunnel syndrome, and 2.7% had it confirmed by both examination and nerve tests [5]. So numbness alone does not prove carpal tunnel syndrome.
  • Fingers involved: the median nerve supplies feeling to the thumb, index and middle fingers and part of the ring finger, so carpal tunnel symptoms usually appear there.
  • Both hands: carpal tunnel syndrome can affect one or both hands.

Why does carpal tunnel syndrome happen? Diabetes, weight, thyroid and the wrist

The NHS lists being overweight, pregnancy, repetitive wrist bending or hard gripping, arthritis, diabetes, a family history and a previous wrist injury as risk factors [1]. Large reviews link carpal tunnel syndrome with diabetes, excess weight and, less strongly, an underactive thyroid:

  • Diabetes: in a 2016 meta-analysis in Diabetic Medicine (18 studies, more than 37 million people), diabetes raised the odds of carpal tunnel syndrome by 69% after adjusting for other factors, for both type 1 and type 2 diabetes [2].
  • Weight: in a 2015 meta-analysis of 58 studies in Obesity Reviews, obesity about doubled the risk, and each one-point rise in body mass index raised it by 7.4% [3].
  • Thyroid: in a 2014 meta-analysis in Muscle & Nerve, hypothyroidism was linked with a modest rise in risk (1.44 times after adjustment), and part of this may be due to other factors [4].
  • Pregnancy: in a 2015 BJOG study, 34% of 639 pregnant women reported carpal tunnel symptoms, mostly mild, more severe after 32 weeks and more common with fluid retention [6].
  • Computer and mouse work: the research is mixed; in a 2015 meta-analysis in the Journal of the Neurological Sciences, among office workers, computer and mouse use were linked with carpal tunnel syndrome, while computer workers as a group did not have more of it than other groups [7].
  • Cure4Pain’s clinic observation: the most common finding in Cure4Pain’s carpal tunnel patients is a nutrient deficiency together with diabetes, a thyroid problem or weight gain. This is a clinic observation; individual results vary, and further studies are needed. See our Type 2 Diabetes, Hypothyroidism and Metabolic Syndrome pages.

Is it carpal tunnel syndrome or something else?

Several problems can cause numbness or tingling in the hand, and more than one can be present:

  • A pinched nerve in the neck: a neck nerve root problem can cause arm and hand symptoms, and a neck problem and carpal tunnel syndrome can occur together, sometimes called “double crush” [8]; see our Pinched Nerve & Radiculopathy and Neck Pain & Cervical Spondylosis pages.
  • Nerve damage from diabetes or low vitamin B12: vitamin B12 deficiency can cause neurological changes, and metformin and acid-reducing medicines can lower B12, according to the US National Institutes of Health [9]; see our Neuropathy page.
  • Elbow and forearm pain: see our Tennis Elbow & Elbow Pain page.
  • Inflammatory arthritis: arthritis is a risk factor for carpal tunnel syndrome [1]; see our Rheumatoid Arthritis page.

How is carpal tunnel syndrome diagnosed?

Diagnosis rests on the symptoms and an examination, with a nerve conduction test (often called an NCV or EMG-NCV test in India) when the picture is unclear or severe. A nerve conduction test measures how fast signals pass through the median nerve at the wrist; in the JAMA population study, only 2.7% of adults had carpal tunnel syndrome confirmed by both examination and nerve tests [5].

  • Examination: where the numbness is, thumb strength, and simple wrist tests (Tinel’s and Phalen’s) where needed.
  • Neck check: to look for a pinched nerve in the neck [8].
  • Muscle testing at Cure4Pain: flexor carpi radialis, flexor carpi ulnaris, palmaris longus, pronator teres, opponens pollicis (thumb), pectoralis major and minor, latissimus dorsi, serratus anterior and subclavius.
  • Blood tests at Cure4Pain: our panel of more than 100 measures, including HbA1c, thyroid tests, vitamin B12, vitamin D and rheumatoid factor.

In India, the panel is available at a lower cost through our patient portal, with home collection across India. Outside India, the tests are done at a laboratory near you and reviewed with you in the consultation.

Already advised surgery? What the research says

Some people seek a non-surgical opinion after being advised surgery, often with a nerve conduction report already done. The research supports discussing both options:

  • Surgery: in a 2024 Cochrane review of 14 trials (1,231 people), surgery probably gave more people clinical improvement than a wrist splint after 3 months and reduced the need for later surgery, though it probably did not give a clinically important benefit in symptom scores; overall the benefit of surgery was unclear, and the authors advise balancing its small benefits and potential risks [10]. The NHS offers surgery when carpal tunnel syndrome is getting worse and other treatments have not helped [1].
  • Steroid injections: a 2023 Cochrane review found that a local steroid injection is effective for mild and moderate carpal tunnel syndrome, with benefits lasting up to six months and a reduced need for surgery up to 12 months [11]. We do not give injections at Cure4Pain.
  • Trying non-surgical care first: for mild and moderate carpal tunnel syndrome, many people try a period of non-surgical care first, and surgery remains an option if symptoms do not improve; a small 2025 trial of dry needling is described below [12].
  • Severe cases first to the surgeon: thumb muscle wasting, constant numbness or worsening weakness go to a hand surgeon first, and we take patients on afterwards under the surgeon’s guidance.
  • The decision is yours, with your surgeon: we share our findings with your surgeon, and surgery can follow if non-surgical care does not help.

How does Cure4Pain treat carpal tunnel syndrome?

Cure4Pain treats mild and moderate carpal tunnel syndrome without surgery or injections, in one or both hands, including symptoms that return after surgery and carpal tunnel syndrome in pregnancy, using myofascial release with dry needling, electroacupuncture, muscle exercises and correction of deficiencies found on blood tests. In Cure4Pain’s experience this simple approach relieves many people; if symptoms are not improving after 6 to 8 weeks of care, surgery can still follow. Carpal tunnel syndrome sometimes improves by itself [1], so part of any improvement may be natural recovery; individual results vary, and further studies are needed. The plan includes:

  1. Assessment first: examination and neck check, muscle testing, nerve conduction tests when needed, and our blood panel.
  2. Dry needling guided by the local twitch response for the thumb-base (thenar) and forearm muscles, with electroacupuncture, myofascial release and cupping where needed.
  3. Schedule: usually twice a week for 6 weeks, with progress reviewed at 6 to 8 weeks; care usually lasts 6 to 12 weeks in all.
  4. Nutritional supplementation: deficiencies found on blood tests are corrected, for example vitamin B12, vitamin B1 (thiamine) or vitamin D (standard supplement doses), with omega-3 and protein where diet shows a need; vitamin B6 only within the European Food Safety Authority limit of 12 mg a day [13].
  5. Diabetes, thyroid and weight: diet support for blood sugar, thyroid and weight, with Dr Krushal Pabari managing diabetes and thyroid treatment.
  6. Exercise: nerve-gliding and muscle exercises at home, set for each person.
  7. Daily life: advice on keyboard and phone use, kitchen work such as chopping and rolling, two-wheeler grips and avoiding sleeping with bent wrists.
  8. Medicines and pregnancy: Dr Krushal Pabari reviews and manages painkillers and nerve-pain tablets, and manages carpal tunnel syndrome in pregnancy with your gynaecologist. We do not give injections.

Does dry needling or acupuncture help carpal tunnel syndrome?

Some trials suggest they help: in a 2023 meta-analysis of 16 randomised trials (1,025 people) in Frontiers in Neuroscience, most with some risk of bias, acupuncture eased pain more than night splints, had no advantage over medicines for symptom severity or nerve tests, and may help as an add-on treatment [14]. In a sham-controlled trial published in Brain, electroacupuncture changed how the brain maps the hand, and these changes predicted longer-term improvement [15].

  • Dry needling: in a pilot randomised trial in Physiotherapy Theory and Practice (2023) of manual labourers with mild to moderate carpal tunnel syndrome, dry needling of thumb-base trigger points improved grip, pinch and function at 2 weeks [16]; in a small 2025 randomised trial in the Journal of Bodywork and Movement Therapies using a specific technique (fascial winding), fewer wrists in the dry needling group needed surgery by 12 weeks (a 62% lower risk) than in the control group [12]. Larger, longer trials are needed.
  • Twitch response: needling that produced local twitch responses reduced spinal pain more immediately after treatment than needling without a twitch response, but not at short-term follow-up; Cure4Pain found no such trial in carpal tunnel syndrome [17].
  • Cure4Pain’s method: Cure4Pain found no controlled trial of the exact combination of myofascial release, dry needling, muscle exercises and supplementation for carpal tunnel syndrome.

Do exercises or wrist splints help?

The evidence is limited for both. A 2012 Cochrane review of 16 trials found limited, very low-quality evidence for exercise and mobilisation [18], and a systematic review found that nerve-gliding exercises might help recover hand function, with more research needed [19]. The NHS notes that hand exercises may ease symptoms though evidence is limited [1].

  • Splints: a 2023 Cochrane review of 29 trials found insufficient evidence to say whether splinting helps; low-certainty evidence suggests night-time splints may give a greater chance of overall improvement than no treatment [20]. The NHS suggests a night splint, which may take up to 6 weeks to help [1]. At Cure4Pain, night splints are rarely used.

Do vitamins help carpal tunnel syndrome?

The evidence is limited, and there is no controlled trial of vitamin B1 and B12 on their own for carpal tunnel syndrome. The 2025 guideline summary from the American Academy of Orthopaedic Surgeons lists nutritional supplementation among non-operative treatments that do not show superiority over control or placebo, with a “Limited” strength rating, which leaves room for clinical judgment and patient preference [21]. As clinic practice, we correct deficiencies found on blood tests as one part of the plan.

  • B vitamins: in a 2025 placebo-controlled trial in BMC Neurology, alpha-lipoic acid with a vitamin B complex improved pain scores but not hand function or nerve test results [22].
  • Vitamin B6, with care: high vitamin B6 levels from supplements can cause a sensory neuropathy [23]; the US upper limit for adults is 100 mg a day, and the European Food Safety Authority set a lower limit of 12 mg a day in 2023, according to the US National Institutes of Health [13].
  • Vitamin B12: deficiency can cause neurological changes and is more likely with metformin or acid-reducing medicines [9], so Cure4Pain tests B12 in every patient.
  • Vitamin D: a 2021 systematic review in the Journal of Experimental Orthopaedics, based on a few small studies, found that vitamin D supplements may improve pain, function and nerve conduction in carpal tunnel syndrome, though no standard dose has been set [24]. The upper limit for adults is 4,000 IU a day, according to the US National Institutes of Health [25].
  • Cure4Pain’s clinic observation: correcting deficiencies together with myofascial release and exercise helps many of our patients; this is a clinic observation, part of the improvement may be natural recovery, individual results vary, and further studies are needed.

Do painkillers help?

Paracetamol or ibuprofen may help for a short time, but there is little evidence that they treat the cause of carpal tunnel syndrome, according to the NHS [1]. At Cure4Pain, Dr Krushal Pabari reviews and manages painkillers and nerve-pain tablets under clinical guidance from Team Cure4Pain. Never stop or change prescribed medicines without medical guidance.

Carpal tunnel syndrome in pregnancy

Carpal tunnel symptoms are common in pregnancy, reported by 34% of women in one study, mostly mild and more severe late in pregnancy [6]. During pregnancy, care is managed by Dr Krushal Pabari in association with your gynaecologist. At Cure4Pain, women around menopause and people with diabetes or thyroid disease are among the patients seen most often; this is a clinic observation, individual results vary, and further studies are needed.

How long does carpal tunnel treatment take?

At Cure4Pain, sessions are usually twice a week for 6 weeks, progress is reviewed at 6 to 8 weeks, and care usually lasts 6 to 12 weeks; if symptoms are not improving, surgery can be considered with your surgeon. Carpal tunnel syndrome sometimes gets better by itself in a few months [1], so part of any improvement may be natural recovery. This is clinic practice; individual results vary, and further studies are needed.

When should you see a doctor urgently?

See a doctor if carpal tunnel symptoms are getting worse or not going away, or if home treatment is not working, according to the NHS [1]. Thumb muscle wasting, constant numbness or worsening weakness need a hand surgeon promptly.

Which doctor should I see for carpal tunnel syndrome?

In India, many people first see an orthopaedic doctor or a neurologist, who arranges a nerve conduction test; a hand surgeon (an orthopaedic or plastic surgeon who specialises in the hand) treats severe or worsening cases, and the NHS refers worsening cases to a specialist [1]. At Cure4Pain, Dr Krushal Pabari and AT. Chintan Dalal, N.D. work alongside your surgeon for non-surgical care.

Does Cure4Pain work with my doctor?

Yes. Cure4Pain works alongside your existing consulting physician, orthopaedic or hand surgeon, neurologist and gynaecologist, shares its findings with them, and any change to medicines is made under clinical guidance from Team Cure4Pain, in coordination with them.

How do I book a consultation?

Please register your case on our patient portal with your latest blood tests, nerve conduction report, X-ray or MRI reports and medical history. We take patients on only after reviewing these reports and an assessment. Consultations are in person in Mumbai or online. Dry needling, acupuncture and other hands-on treatments are given only at our Mumbai clinic, so if in-person treatment is advised, please book when you can attend in Mumbai. Registrations and appointments are made only through our patient portal.

Evidence: key studies

StudyWhat it found
NHS, Carpal tunnel syndrome [1]Night splint, steroid injection if needed, surgery for worsening cases; may settle by itself.
Atroshi et al., JAMA 1999 [5]14.4% had hand symptoms; 3.8% had clinically certain carpal tunnel syndrome.
Pourmemari et al., Diabet Med 2016 [2]Diabetes: 69% higher odds after adjustment.
Shiri et al., Obes Rev 2015 [3]Obesity about doubled the risk.
Lusa et al., Cochrane 2024 [10]Benefit of surgery over non-surgical care unclear.
Ashworth et al., Cochrane 2023 [11]Steroid injection effective for up to six months in mild and moderate cases.
Karjalainen et al., Cochrane 2023 [20]Insufficient evidence; night splints may help some people.
Dong et al., Front Neurosci 2023 [14]Acupuncture eased pain more than night splints.
Gascon-Garcia et al., J Bodyw Mov Ther 2025 [12]Dry needling lowered the need for surgery at 12 weeks (small trial).

Carpal Tunnel Syndrome FAQs

Can carpal tunnel syndrome be treated without surgery?

Often, yes, for mild and moderate cases: the NHS starts with a night splint and, if needed, a steroid injection, and offers surgery when symptoms get worse [1]; a Cochrane review found the benefit of surgery over non-surgical care unclear [10]. Severe cases with thumb wasting go to a hand surgeon first.

Who treats carpal tunnel syndrome without surgery in Mumbai?

Cure4Pain, an integrative and functional medicine clinic in Malad West, Mumbai, led by Dr Krushal Pabari (MD, PGCP Rheumatic & Musculoskeletal Diseases) and AT. Chintan Dalal, N.D. (BNYS, R.AP), combines myofascial release with dry needling, electroacupuncture, muscle exercises and nutritional supplementation, without surgery or injections. Consultations are in Mumbai or online.

Which vitamin deficiency causes carpal tunnel syndrome?

No single vitamin deficiency has been proven to cause it. Low vitamin B12 can cause nerve symptoms that look similar [9], vitamin D supplements improved symptoms in small studies [24], and too much vitamin B6 can itself damage nerves [23][13]. Diabetes, weight and thyroid disease are better-established risk factors [2][3][4].

B12 or B6: which is better for carpal tunnel syndrome?

Neither has strong trial evidence for carpal tunnel syndrome on its own. B12 is checked because deficiency causes nerve symptoms [9]; B6 must stay within official limits because high doses can cause nerve damage [13].

Is carpal tunnel surgery risky?

Carpal tunnel surgery is a short operation under local anaesthetic, and the NHS describes a return to normal activities in about a month [1]; every operation has risks, and a Cochrane review advises balancing the small benefits and the potential risks [10]. Your surgeon explains the risks for your case.

Does carpal tunnel syndrome go away on its own?

Sometimes: it sometimes gets better by itself in a few months, particularly in pregnancy, according to the NHS [1]. Symptoms that get worse or do not go away need a doctor.

Haath sunn hona or hath mein jhunjhuni (हाथ में झुनझुनी): is it always carpal tunnel, and what is commonly mistaken for it?

No. Numb or tingling hands have many causes, including a pinched nerve in the neck, diabetes and low vitamin B12; in a population study, only about a quarter of people with hand numbness and tingling had clinically certain carpal tunnel syndrome [5]. An examination, and nerve tests when needed, tell them apart.

Can vitamin B12 help hand numbness?

Vitamin B12 helps when numbness comes from a B12 deficiency, which the US National Institutes of Health links with nerve changes [9]; it has not been shown to treat carpal tunnel syndrome itself.

When should I worry about hand numbness and tingling?

See a doctor if symptoms are getting worse, not going away, or home treatment is not working, according to the NHS [1]; thumb muscle wasting, constant numbness or worsening weakness need a hand surgeon promptly.

Why are carpal tunnel symptoms worse at night?

Symptoms are usually worse at night, according to the NHS, which suggests a night splint to keep the wrist straight [1]; at Cure4Pain we also advise avoiding sleeping with bent wrists.

Can physiotherapy or exercises help carpal tunnel syndrome?

Hand exercises may ease symptoms, but the evidence is limited [1][18]; nerve-gliding exercises might help hand function [19]. At Cure4Pain, nerve-gliding and muscle exercises are part of the home plan.

What test confirms carpal tunnel syndrome?

An examination of symptoms and hand strength, with a nerve conduction test (NCV) when needed; in a JAMA population study, only 2.7% of adults had carpal tunnel syndrome confirmed by both examination and nerve tests, though 14.4% had hand symptoms [5].

Can I consult online, and where are treatments given?

Yes, consultations are in person in Mumbai or online worldwide, after you register your case with your tests and reports on our patient portal. Dry needling, acupuncture and other hands-on treatments are given only at our Mumbai clinic in Malad West.

How much does carpal tunnel treatment cost at Cure4Pain?

The consultation fee, in Mumbai or online, is shown when you book. In India, the blood panel is available at a lower cost through our patient portal, with home collection.

Who treats you

  • Dr Krushal PabariMD, PGCP - Rheumatic & Musculoskeletal Diseases. Assistant Professor, Cooper Hospital; Guest Professor, CMP Homoeopathic Medical College.
  • AT. Chintan Dalal, N.D.BNYS, R.AP. Functional nutrition and Coimbra Protocol practitioner.

Consultations look at the whole person: alongside the medical and nutritional plan, we bring a strong interest in behavioural science to counselling on stress, sleep and lasting lifestyle change.

How consultations work: Mumbai or online worldwide

Book through our patient portal. You can see us in person at our clinic in Malad West, Mumbai, or online from anywhere. Your first consultation reviews your history and tests; we then agree a plan together and set the monitoring schedule.

Book Appointment

Related conditions and articles

This page is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

1. NHS. Carpal tunnel syndrome. nhs.uk/conditions/carpal-tunnel-syndrome

2. Pourmemari MH, Shiri R. Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med 2016;33(1):10-6. doi:10.1111/dme.12855

3. Shiri R, et al. The effect of excess body mass on the risk of carpal tunnel syndrome: a meta-analysis of 58 studies. Obes Rev 2015;16(12):1094-104. doi:10.1111/obr.12324

4. Shiri R. Hypothyroidism and carpal tunnel syndrome: a meta-analysis. Muscle Nerve 2014;50(6):879-83. doi:10.1002/mus.24453

5. Atroshi I, et al. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999;282(2):153-8. doi:10.1001/jama.282.2.153

6. Meems M, et al. Prevalence, course and determinants of carpal tunnel syndrome symptoms during pregnancy: a prospective study. BJOG 2015;122(8):1112-8. doi:10.1111/1471-0528.13360

7. Shiri R, Falah-Hassani K. Computer use and carpal tunnel syndrome: A meta-analysis. J Neurol Sci 2015;349(1-2):15-9. doi:10.1016/j.jns.2014.12.037

8. Kane PM, et al. Double Crush Syndrome. J Am Acad Orthop Surg 2015;23(9):558-62. doi:10.5435/JAAOS-D-14-00176

9. Office of Dietary Supplements, US National Institutes of Health. Vitamin B12: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional

10. Lusa V, et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev 2024;1(1):CD001552. doi:10.1002/14651858.CD001552.pub3

11. Ashworth NL, et al. Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database Syst Rev 2023;2(2):CD015148. doi:10.1002/14651858.CD015148

12. Gascon-Garcia J, et al. Efficacy of dry needling with the fascial winding technique in reducing the percentage of surgery in carpal tunnel syndrome: A randomized clinical trial. J Bodyw Mov Ther 2025;42:408-416. doi:10.1016/j.jbmt.2025.01.015

13. Office of Dietary Supplements, US National Institutes of Health. Vitamin B6: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional

14. Dong Q, et al. Acupuncture for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials. Front Neurosci 2023;17:1097455. doi:10.3389/fnins.2023.1097455

15. Maeda Y, et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain 2017;140(4):914-927. doi:10.1093/brain/awx015

16. Rezazadeh M, et al. Short-term effects of dry needling of thenar muscles in manual laborers with carpal tunnel syndrome: a pilot, randomized controlled study. Physiother Theory Pract 2023;39(5):927-937. doi:10.1080/09593985.2022.2033897

17. Fernández-de-Las-Peñas C, et al. The importance of the local twitch response during needling interventions in spinal pain associated with myofascial trigger points: a systematic review and meta-analysis. Acupunct Med 2022;40(4):299-311. doi:10.1177/09645284211056346

18. Page MJ, et al. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database Syst Rev 2012;2012(6):CD009899. doi:10.1002/14651858.CD009899

19. Ballestero-Pérez R, et al. Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review. J Manipulative Physiol Ther 2017;40(1):50-59. doi:10.1016/j.jmpt.2016.10.004

20. Karjalainen TV, et al. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev 2023;2(2):CD010003. doi:10.1002/14651858.CD010003.pub2

21. Shapiro LM, et al. American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome. J Am Acad Orthop Surg 2025;33(7):e356-e366. doi:10.5435/JAAOS-D-24-01179

22. Zainal NA, et al. Evaluating the efficacy and tolerability of the oral combination of alpha lipoic acid and vitamin B complex preparation in carpal tunnel syndrome: a single center, randomized, double-blind, placebo-controlled trial. BMC Neurol 2025;26(1):7. doi:10.1186/s12883-025-04430-y

23. Muhamad R, et al. The Role of Vitamin B6 in Peripheral Neuropathy: A Systematic Review. Nutrients 2023;15(13). doi:10.3390/nu15132823

24. Anusitviwat C, et al. The effects of vitamin D supplementation in carpal tunnel syndrome treatment outcomes: a systematic review. J Exp Orthop 2021;8(1):73. doi:10.1186/s40634-021-00393-4

25. Office of Dietary Supplements, US National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminD-HealthProfessional

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