Comparative Effectiveness and Cost Considerations of Manual Therapy Techniques in Peripheral Nerve Entrapments: A Narrative Review of Recent Evidence (2021–2024)

Abstract

Background: Peripheral nerve entrapments are common neuromuscular disorders that cause pain, sensory disturbance, and functional impairment, with increasing emphasis on conservative, non-surgical management. Objective: To synthesize recent evidence (2021–2024) on the clinical effectiveness and cost-related considerations of manual therapy techniques—neural mobilization, Maitland mobilization, the Mulligan concept, myofascial release, and Cyrix friction massage—for peripheral nerve entrapments. Methods: This narrative review searched PubMed/MEDLINE, Scopus, Google Scholar, and PEDro for English-language, peer-reviewed studies published from January 2021 to December 2024 (search conducted and updated in January 2025), supplemented by hand-searching reference lists. Eligible studies included adults with clinically or electrophysiologically diagnosed entrapment neuropathies receiving one or more target manual therapy techniques. Results: Thirty-two studies were included (14 randomized controlled trials, 6 non-randomized/quasi-experimental studies, 5 observational/case series studies, and 7 systematic reviews/meta-analyses), most frequently addressing carpal tunnel syndrome. Across conditions, neural mobilization and Mulligan-based interventions showed the most consistent improvements in pain and functional outcomes, with occasional accompanying gains in grip strength and nerve conduction parameters in carpal tunnel syndrome. Maitland mobilization and myofascial release demonstrated mixed or adjunctive benefits, while Cyrix friction massage showed limited and inconsistent effects. No study reported formal cost-effectiveness outcomes; cost-related findings were restricted to indirect indicators such as session burden and treatment duration. Conclusion: With moderate certainty and acknowledging heterogeneous protocols and variable risk-of-bias across primary studies, neural mobilization and the Mulligan concept appear to be the most consistently supported manual therapy options for conservative management of peripheral nerve entrapments, while other techniques may be considered adjunctive based on clinical presentation. Future trials should prioritize standardized protocols, longer follow-up, and integrated health-economic outcomes.