This systematic review and meta-analysis included 12 randomized controlled trials comprising a diverse population of patients diagnosed with carpal tunnel syndrome. The study aimed to compare the efficacy of local corticosteroid injection versus various forms of physical therapy. Pooled outcomes of interest included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, Visual Analogue Scale (VAS) scores for pain, and neurophysiological parameters such as distal motor latency (DML) and compound muscle action potential (CMAP). The analysis revealed that while there were no significant differences between treatments in terms of BCTQ scores and VAS scores, local corticosteroid injection was associated with better improvements in DML and CMAP compared to physical therapy, suggesting a potential superiority in electrophysiological outcomes.