Carpal Tunnel Syndrome is a common condition affecting the wrist and hand, characterized by symptoms like pain, numbness, and tingling. It occurs when the median nerve, which runs through a narrow passageway in the wrist called the carpal tunnel, becomes compressed. Understanding which medical professionals diagnose and treat this condition is an important step toward finding effective relief and managing symptoms.
Understanding Carpal Tunnel Syndrome
Carpal Tunnel Syndrome (CTS) involves increased pressure within the carpal tunnel, compressing the median nerve. This tunnel is formed by carpal bones and the transverse carpal ligament. The median nerve provides sensation to the thumb, index, middle, and half of the ring finger, and controls muscles at the base of the thumb. Symptoms include numbness, tingling, weakness, and pain in these specific fingers and the hand.
They often begin gradually and may worsen at night, sometimes waking individuals from sleep. People might experience a “pins and needles” sensation or a feeling like an electric shock. Common risk factors include repetitive hand motions, sustained wrist flexion or extension, and exposure to vibration. Certain medical conditions such as rheumatoid arthritis, diabetes, thyroid disorders, and fluid retention from pregnancy or menopause can also increase CTS likelihood.
First Steps in Seeking Care
For symptoms suggestive of Carpal Tunnel Syndrome, a primary care physician (PCP) is typically the initial point of contact for diagnosis and guiding treatment. During this first visit, the physician gathers information about the patient’s symptoms, medical history, and daily activities. A physical examination assesses sensation in the fingers, hand strength, and muscle atrophy. The physician may also conduct specific tests, such as bending the wrist or tapping on the nerve, to trigger symptoms and aid diagnosis. PCPs provide initial advice, suggest conservative management strategies, or refer patients to specialists if symptoms are severe or unresponsive to initial treatments.
Specialized Medical Professionals
When initial conservative treatments are insufficient or symptoms are more severe, a primary care physician may refer a patient to a specialized medical professional. These specialists offer more advanced diagnostic tools or interventions.
Orthopedic Surgeons
Orthopedic surgeons frequently diagnose and manage hand and wrist conditions, including Carpal Tunnel Syndrome. These specialists can offer both non-surgical interventions and surgical procedures.
Neurologists
Neurologists specialize in disorders of the nervous system and diagnose nerve-related conditions like CTS. They utilize advanced diagnostic tools such as nerve conduction studies and electromyography (EMG) to assess nerve damage and confirm diagnosis. These tests measure electrical activity in muscles and nerve impulse speed.
Physiatrists
Physiatrists, also known as Physical Medicine and Rehabilitation (PM&R) physicians, focus on restoring function and reducing pain without surgery. They perform detailed physical examinations of nerves, muscles, and tendons, and may use ultrasound or EMG for diagnosis. Physiatrists guide rehabilitation plans, which can include prescribing wrist splints, hand exercises, and activity modifications.
Occupational and Physical Therapists
Occupational therapists (OTs) and physical therapists (PTs) provide hands-on conservative treatments and patient education. They assist with splinting, ergonomic advice, and activity modification to reduce nerve compression. Therapists also teach specific exercises, such as nerve and tendon gliding, to improve mobility and reduce symptoms, often playing a role in post-surgical rehabilitation.
Pathways to Treatment
Treatment for Carpal Tunnel Syndrome typically begins with conservative, non-surgical approaches, especially in mild to moderate cases or when symptoms are recent. Wrist splinting is a common initial treatment, particularly at night, to hold the wrist in a neutral position and reduce pressure on the median nerve. Activity modification, which involves changing how daily tasks are performed to avoid aggravating movements, is also recommended. Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for short-term pain relief.
Corticosteroid injections into the carpal tunnel can decrease inflammation and swelling, providing temporary relief by reducing pressure on the nerve. Hand therapy, including specific exercises to improve nerve and tendon gliding, can also be part of conservative management.
If conservative treatments do not alleviate symptoms, or if the condition is severe, surgical intervention may be considered. Carpal tunnel release surgery aims to relieve pressure on the median nerve by cutting the transverse carpal ligament. This procedure can be performed using an open technique, involving a larger incision, or endoscopically, using smaller incisions and a camera for guidance. Both surgical methods aim to create more space for the nerve, and recovery typically involves a period of rehabilitation.