OBJECTIVES: To conduct a systematic review to compare the efficacy of surgical versus non-surgical treatment of carpal tunnel syndrome (CTS). METHODS: We searched Embase, Medline & Cochrane databases from January 2000 to June 2015 and included all randomised controlled trials comparing any surgical versus non-surgical therapies in patients with CTS. Two authors independently assessed the eligibility of the trials and performed all the necessary steps of a systematic review. A qualitative analysis of the results was done. RESULTS: From the 112 studies retrieved, five studies reached the stage of data extraction. Three studies compared decompressive surgery with local steroid injection, one study compared surgical versus non-surgical (hand therapy and ultrasound) and the last study compared surgery versus splinting, respectively. The studies included 95 wrists, 163 wrists, 50 patients, 116 patients and 176 patients. The study with 50 patients reported that at 20 weeks patients who underwent surgery had greater symptomatic improvement than those who were injected with steroids. The mean improvement in GSS after 20 weeks was 24.2 (SD 11.0) in the surgery group vs 8.7 (SD 13.0) in the injection group (p < 0.001). Similarly, the other two trials comparing surgery with steroid injection reported that surgery has additional benefits in improving CTS. The trial comparing surgery with splinting reported a success rate of 90% with surgery as compared to 75% with splinting. The trial with surgery versus non-surgery revealed a significant 12-month adjusted advantage for surgery in function (CTSAQ function score: Delta -0.40, 95% CI 0.11-0.70, p=0.0081) and symptoms (CTSAQ symptom score: 0.34, 0.02-0.65, p=0.0357). CONCLUSIONS: Surgical treatment of CTS relieves symptoms significantly better compared to non-surgical treatment. Further, the surgical treatment was a better option as compared to local steroid injections and splinting.