Conservative management of carpal tunnel syndrome during pregnancy and lactation: A systematic review of mixed study designs.

BACKGROUND: Pregnancy-related carpal tunnel syndrome (PRCTS) is the most common entrapment neuropathy during pregnancy, caused by gestational hormonal changes and fluid retention leading to increased intracarpal pressure and median nerve compression. Although symptoms often resolve postpartum, many patients experience significant functional impairment. Conservative treatment is preferred due to maternal-fetal safety concerns, but comparative evidence across modalities remains heterogeneous. This systematic review aimed to evaluate the effectiveness of conservative and minimally invasive interventions for PRCTS.

METHODS: The review protocol was registered in PROSPERO (CRD420261308958). A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to 24 November 2025 (full search strategies in Supplementary Table S1). Studies evaluating conservative or minimally invasive treatments for CTS during pregnancy or lactation were included, irrespective of study design; case reports and case series without a comparator group were excluded a priori. Two independent reviewers performed study selection, data extraction, and methodological quality assessment using the National Institutes of Health (NIH) Quality Assessment Tools selected according to study design, and outcome-level certainty of evidence was additionally rated using the GRADE approach. Because of clinical and methodological heterogeneity, meta-analysis was not feasible; findings were synthesized qualitatively and supplemented with descriptive pooled summaries of reported outcomes by intervention.

RESULTS: Twelve studies met inclusion criteria. Night wrist splinting consistently improved symptoms in mild-to-moderate cases, particularly when combined with nerve and tendon gliding exercises. Ultrasound-guided corticosteroid injections provided effective short-term symptom relief in severe or refractory cases and appeared acceptable based on limited available evidence; however, no formal safety analysis was possible. Evidence supporting adjunct therapies, including kinesio taping, cupping, and laser therapy, was limited and inconsistent. Certainty of evidence, rated using GRADE, was low to very low for all principal outcomes, reflecting small sample sizes, methodological heterogeneity, and imprecision (Table 1b).

CONCLUSION: Night splinting remains the first-line treatment for PRCTS, with corticosteroid injection as a potential option for refractory cases when benefits outweigh risks. Further high-quality studies are needed to establish standardized treatment protocols and long-term maternal-fetal safety.