Carpal Tunnel Syndrome (CTS) results from the compression of the median nerve within the carpal tunnel, a narrow passageway in the wrist. This compression typically causes numbness, tingling, and pain in the hand and fingers. When non-surgical methods fail, Carpal Tunnel Release (CTR) surgery is often recommended. This procedure is one of the most frequently performed surgeries in the United States. Several kinds of surgeons from multiple medical specialties are fully qualified to perform the operation.
The Primary Surgical Specialists
Three major surgical specialties routinely perform Carpal Tunnel Release. Orthopedic surgeons focus on the musculoskeletal system, including the bones, joints, ligaments, and tendons of the hand and wrist. Many complete specialized fellowship training in hand surgery, making them experts in carpal tunnel anatomy.
Plastic surgeons also commonly perform this procedure, leveraging expertise in soft tissue handling, micro-surgery, and nerve reconstruction. Their training includes detailed work on complex tissue repair and the delicate structures of the hand, which requires precision for nerve decompression.
Neurosurgeons specialize in conditions affecting the nervous system, including peripheral nerves. Their primary focus is on the median nerve itself and treating nerve compression disorders throughout the body.
The key factor determining a surgeon’s qualification is the completion of advanced, specialized training, not the initial residency program. Many surgeons pursue a one-year fellowship in hand surgery after residency. This training leads to the Subspecialty Certificate in Surgery of the Hand. A specialist with this certification is considered highly qualified to perform carpal tunnel release, regardless of their primary background in Orthopedics, Plastic Surgery, or Neurosurgery.
The Diagnostic and Referral Team
Several medical specialists are involved in the diagnostic and conservative management process before a patient sees a surgeon. This process often begins with a primary care physician (PCP) or internal medicine doctor. The PCP manages initial symptoms and recommends first-line conservative treatments, such as night splinting, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs).
If symptoms persist, the PCP may refer the patient to a neurologist or a physical medicine and rehabilitation (PM&R) specialist. Neurologists perform electrodiagnostic studies, specifically Nerve Conduction Studies (NCS) and Electromyography (EMG). These tests confirm the diagnosis, assess the severity of median nerve compression, and rule out other conditions.
Physical Medicine and Rehabilitation specialists, also called physiatrists, focus on restoring function and managing pain through non-surgical means. They oversee conservative treatments, prescribe specialized physical therapy, and may perform corticosteroid injections, often guided by ultrasound. The physiatrist’s goal is to maximize function without surgery before a patient is referred to a surgical specialist.
Selecting the Right Surgeon
When choosing a surgeon for carpal tunnel release, patients should prioritize credentials demonstrating focused expertise. The most important indicator of advanced capability is the Subspecialty Certificate in Surgery of the Hand. This certification confirms the surgeon has training and experience beyond the scope of a general orthopedic, plastic, or neurosurgeon.
Patients should also inquire about the surgeon’s annual volume of carpal tunnel procedures. A higher volume suggests greater familiarity and efficiency with the technique. Additionally, patients should discuss the surgeon’s preferred surgical method, such as the traditional open release or the less invasive endoscopic technique.
The overall success rate for carpal tunnel release is high, with symptom relief reported in 75% to over 90% of cases. During the consultation, the surgeon should clearly define what a successful outcome means for the patient. Finding a surgeon who communicates clearly, explains the risks, and has demonstrated expertise provides the best pathway to a positive surgical outcome.