Carpal Tunnel Syndrome (CTS) is a common condition caused by compression of the median nerve as it passes through the carpal tunnel, a narrow passageway in the wrist. This pressure typically results in symptoms such as numbness, tingling, and pain affecting the thumb, index, middle, and half of the ring finger. Symptoms frequently worsen at night or during activities involving gripping or repetitive wrist motion. The medical journey begins with initial screening and progresses to specialized care based on the severity and persistence of symptoms.
Starting the Journey: Primary Care and Initial Diagnosis
Most individuals begin their evaluation with a Primary Care Physician (PCP) or General Practitioner. The PCP serves as the initial screener, taking a detailed history of symptoms and performing a physical examination that includes provocative tests intended to reproduce the symptoms.
These initial tests often include Phalen’s maneuver (holding wrists fully flexed) and Tinel’s sign (lightly tapping over the median nerve). The presence of tingling or pain during these maneuvers suggests nerve irritation.
Initial management for mild cases focuses on conservative, non-invasive approaches. This first-line treatment typically involves prescribing a wrist splint to be worn at night and recommending nonsteroidal anti-inflammatory drugs (NSAIDs). If symptoms are persistent, the PCP will generally refer the patient to a specialist for advanced diagnostics and treatment.
Specialists for Non-Surgical Treatment and Advanced Diagnostics
If symptoms do not respond to initial conservative measures, or if the diagnosis remains unclear, a referral to a specialist for definitive testing and advanced non-surgical treatment is the next step. Neurologists are frequently involved, as their expertise lies in diagnosing nervous system disorders. The neurologist’s primary role is to confirm the presence and severity of median nerve compression using electrodiagnostic studies.
These studies include Nerve Conduction Studies (NCS), which measure how quickly electrical signals travel down the median nerve, and Electromyography (EMG), which assesses muscle electrical activity. Slower nerve conduction velocities indicate nerve compression. The EMG helps rule out other conditions like cervical radiculopathy, a pinched nerve in the neck.
Another specialist consulted for advanced non-surgical management is a Physiatrist, a physician specializing in Physical Medicine and Rehabilitation (PMR). Physiatrists focus on restoring function and minimizing pain through non-operative means. They commonly administer targeted corticosteroid injections directly into the carpal tunnel sheath to reduce swelling around the median nerve.
Orthopedic physicians also play a role, often overlapping with the Physiatrist in providing conservative care and injections. They may also supervise specialized hand therapy with a certified hand therapist. This therapy involves specific nerve gliding exercises and stretching techniques designed to improve the mobility of the median nerve within the carpal tunnel.
When Surgery is Necessary: Hand and Orthopedic Specialists
If non-surgical treatments fail or if testing reveals severe nerve compression, surgical intervention is the next step. The procedure, known as carpal tunnel release, involves cutting the transverse carpal ligament to increase space and relieve pressure on the median nerve. Specialists who perform this surgery are highly trained in hand and wrist anatomy.
The most common surgical provider is an Orthopedic Surgeon, especially one with fellowship training in hand surgery. These surgeons possess expertise in musculoskeletal structures and manage the bone, tendon, and ligament structures of the wrist. Some Plastic Surgeons also specialize in hand surgery, focusing on the meticulous handling of soft tissues, nerves, and vessels.
A Neurosurgeon may also perform carpal tunnel release, although this is less common. Surgeons generally use one of two techniques: open carpal tunnel release (small incision in the palm) or endoscopic carpal tunnel release (using a camera and smaller incisions).