Carpal Tunnel Syndrome (CTS) results from the compression of the median nerve within the carpal tunnel, a narrow passageway in the wrist. This pressure causes characteristic symptoms like numbness, tingling, and weakness in the hand and fingers, particularly the thumb, index, middle, and half of the ring finger. Finding the right doctor often involves a staged approach, beginning with general medical care before escalating to specialized diagnostic and surgical experts. The severity of nerve compression and the patient’s response to initial treatments dictate which medical professional manages the care.
Initial Assessment and Primary Care
Addressing symptoms often begins with a Primary Care Physician (PCP), such as a doctor of Family Medicine or Internal Medicine. These general practitioners focus on confirming CTS while also ruling out other conditions that mimic its symptoms, such as thyroid issues or nerve compression in the neck (cervical radiculopathy).
The PCP performs a physical examination, including specific maneuvers that apply pressure to the median nerve at the wrist. Phalen’s maneuver involves holding the wrist flexed to reproduce tingling or numbness. Another common test is Tinel’s sign, where the physician gently taps over the median nerve to elicit a shock-like sensation.
If symptoms are mild or recent in onset, the PCP will prescribe initial, conservative management strategies. These include wearing a wrist splint, often worn at night, to keep the wrist in a neutral position and reduce pressure on the nerve. Activity modification and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may also be recommended to manage pain and inflammation. If these first-line treatments fail to provide relief, or if the physical examination suggests muscle wasting or severe sensory loss, the PCP will facilitate a referral to a specialist for advanced care.
Non-Surgical Specialists and Diagnostic Confirmation
When initial care is insufficient, patients are typically referred to non-surgical specialists who can confirm the diagnosis and offer more advanced conservative treatments. Neurologists often perform electrodiagnostic studies, which are considered the gold standard for confirming median nerve compression. These tests include Nerve Conduction Studies (NCS) and Electromyography (EMG), which measure the speed and strength of electrical signals traveling through the nerve.
The NCS results localize the site of nerve compression at the wrist and classify the severity of CTS as mild, moderate, or severe. This precise staging guides treatment decisions and helps rule out other nerve disorders. Physiatrists, who specialize in Physical Medicine and Rehabilitation (PM&R), play a significant role in non-operative management.
These specialists design individualized physical therapy regimens that may include nerve and tendon gliding exercises to help the median nerve move more freely within the carpal tunnel. Physiatrists also frequently administer corticosteroid injections, which deliver anti-inflammatory medication directly into the carpal tunnel space. This injection can provide significant, though often temporary, symptom relief by reducing swelling around the nerve.
A Rheumatologist may also become involved if there is suspicion that the CTS is caused by an underlying systemic inflammatory condition. Conditions like rheumatoid arthritis can cause inflammation in the tendons that pass through the carpal tunnel, increasing pressure on the median nerve. The Rheumatologist focuses on managing the systemic disease, which can subsequently alleviate the compression symptoms in the wrist.
Surgical Options and Specialists
If severe nerve compression is confirmed by electrodiagnostic testing, or if persistent symptoms fail to respond after several months of conservative treatment, a surgical referral is made. Carpal tunnel release involves cutting the transverse carpal ligament to increase the space and relieve pressure on the median nerve. This procedure is most commonly performed by Orthopedic Surgeons specializing in hand and upper extremity surgery.
These surgeons are experts in the musculoskeletal system and perform the release using either an open technique, which involves a small incision in the palm, or an endoscopic technique using a small camera. Hand-specialized Plastic Surgeons also routinely perform carpal tunnel release, given their expertise in the delicate reconstruction of nerves, tendons, and surrounding soft tissues. Both specialties aim to achieve decompression with a high success rate.
Neurosurgeons may also treat CTS, especially in complex situations, or when a patient presents with overlapping neck and hand symptoms. Their particular expertise in the peripheral nervous system means they are often consulted for cases where the diagnosis is unclear or in revision surgeries for recurrent symptoms. Recurrent CTS, which can be caused by excessive scarring around the nerve, may require a neurosurgeon to perform delicate microsurgical techniques to free the nerve sheath and prevent future compression.