Eighty-six wrists from sixty-two patients with mild or moderate carpal tunnel syndrome and a surgical indication were randomized to receive dry needling using the fascial winding technique once weekly for six weeks (n=43), or no intervention (control group, n=43). The primary outcome was the recommendation for surgery at 12 weeks. Secondary outcomes included changes in hand pain, BCTQ symptom and function scores, hand grip and pinch strength, EMG and ultrasound findings, and adverse effects. Overall, the results of the study revealed that dry needling significantly reduced the surgical recommendation rate and improved pain intensity, symptom severity, and hand function, though strength and electrophysiological changes were not significantly different. The findings suggest that dry needling may serve as an effective conservative treatment to avoid surgery in patients with CTS.