Carpal Tunnel Syndrome

Carpal tunnel syndrome is one of the most common conditions I treat. It happens when the median nerve, which supplies sensation and strength to the thumb, index, and middle fingers, becomes compressed as it passes through a narrow tunnel in the wrist.

The good news: with the right diagnosis and a tailored treatment plan, most patients experience significant relief and a return to comfortable, confident hand use.

Common Symptoms

Carpal tunnel syndrome often develops gradually. Symptoms may include:

Numbness or tingling in the thumb, index, and middle fingers
Nighttime symptoms that wake you from sleep
Shaking or “flicking” the hand to relieve discomfort
Pain that travels up the forearm
Weakness when gripping objects, or dropping items
Difficulty with fine tasks like buttoning shirts or handling small tools

Some people notice symptoms only at night or with specific activities, while others feel them throughout the day.

Why It Happens

Carpal tunnel syndrome is usually caused by a combination of factors rather than one single event. These can include:

Repetitive hand or wrist use, especially with flexed wrists
Swelling of tendons in the carpal tunnel
Fluid retention or hormonal changes
Medical conditions such as diabetes, thyroid disease, or inflammatory arthritis
Prior wrist fractures or injuries
An inherited tendency for a narrower carpal tunnel

In many patients, there is no clear “blame,” just a gradual buildup of pressure on the nerve.

Diagnosing CTS

Diagnosis starts with listening to you.

I take time to understand:

Your symptoms and when they occur
Your work and activities
Other medical conditions that may contribute

The physical exam focuses on:

Strength in the hand and thumb
Sensation in different fingers
Specific tests that gently stress the median nerve

Additional studies may include:

Nerve tests (EMG/NCS): Sometimes useful, especially in complex or long-standing cases
Ultrasound: Can visualize the nerve in real time and assess swelling or structural issues

Not every patient needs every test. The goal is a precise diagnosis with the least amount of hassle.

Nonsurgical Treatment Options

Many patients improve without surgery. Nonsurgical options can include:

Night bracing: Keeping the wrist in a neutral position while you sleep
Activity modification: Adjusting hand and wrist positions during work, sports, or hobbies
Targeted injections: A carefully placed corticosteroid injection can reduce swelling around the nerve and provide meaningful relief
Therapy: Hand therapy can address posture, ergonomics, and nerve gliding exercises

For some patients, these measures are enough. For others, they offer partial but temporary relief and help clarify whether surgery will be helpful.

Surgical Treatment

Surgery is considered when:

Symptoms are persistent or worsening
Nighttime waking and functional limits affect daily life
There is measurable nerve damage on exam or testing
Nonsurgical treatments are no longer effective
The goal of surgery is simple: to give the median nerve more room by releasing the tight ligament that forms the “roof” of the carpal tunnel.

We offer a range of modern surgical options, tailored to your needs and medical situation:

Open carpal tunnel release: A small incision in the palm to release the ligament under direct vision
Endoscopic carpal tunnel release: A minimally invasive technique using a small camera and instruments
WALANT (Wide Awake Local Anesthesia No Tourniquet): Surgery performed comfortably with local anesthesia only, avoiding sedation or general anesthesia when appropriate
Surgery is typically done on an outpatient basis, either in an ambulatory surgery center or a carefully selected setting that fits your health and preferences.

Every patient heals at a slightly different pace, but most can expect:

Light use of the hand for simple tasks within a few days
Gradual return to normal use over several weeks
Ongoing improvement in numbness and strength for several months

Pain is usually manageable with a combination of elevation, over-the-counter medication, and a short course of prescription pain medication when needed.

We will review wound care, activity limits, and return-to-work expectations together so you know exactly what to expect.

My Philosophy

My approach is centered on:

Careful listening and clear diagnosis
Starting with the least invasive treatment that has a real chance of helping
Using surgery when it is truly indicated, executed with precision and attention to comfort
Tailoring treatment to your work, hobbies, and goals for your hands

The goal is not only to relieve symptoms, but to help you trust your hands again in the activities that matter to you.