Carpal Tunnel Syndrome 2026 Update: What Physical Therapists Need to Know

Carpal tunnel syndrome (CTS) is still one of the most common nerve compression conditions physical therapists see in the clinic. The 2026 Journal of Orthopedic and Sports Physical Therapy (JOSPT) clinical practice guideline update reinforces a practical message: start with a strong exam, listen closely to the patient’s story, use evidence-supported tools, and know when to refer.

For mild to moderate CTS, the strongest physical therapy-supported intervention remains a forearm-based wrist orthosis that keeps the wrist near neutral, usually worn at night. Ergonomic education, activity modification, manual therapy, selected exercise, kinesiology taping, laser therapy, shockwave therapy, interferential current, superficial heat, and diathermy may help some patients, but many of these recommendations are based on weak or limited evidence.

The big clinical reminder: thenar atrophy, objective weakness, sensory loss, progressive symptoms, atypical presentation, or failed conservative care should raise the referral conversation early.