Which type of doctor treats carpal tunnel syndrome?

Specialists Who Treat Carpal Tunnel Syndrome

Carpal tunnel syndrome is primarily treated by hand surgeons, orthopedic surgeons, plastic surgeons, or neurosurgeons, especially when surgical intervention is required for severe cases or those that have failed conservative management. 1

Initial Management Pathway

Primary Care Management

• Family physicians or primary care providers often manage initial diagnosis and conservative treatment of carpal tunnel syndrome
• They may implement:
  • Night splinting with rigid wrist immobilization brace in neutral position 1
  • Physical therapy referrals 1
  • NSAIDs for short-term pain relief (1-2 weeks) 1
  • Activity modification and ergonomic education 1

Specialist Referrals

• When to refer to specialists:
  • Symptoms persisting beyond 4-6 months of conservative therapy 1
  • Development of thenar muscle atrophy 1
  • Severe symptoms or significant functional limitations 1
  • Need for diagnostic confirmation with specialized testing 2

Types of Specialists for Carpal Tunnel Syndrome

Surgical Specialists

1. Hand Surgeons - Subspecialists with focused training in hand conditions
2. Orthopedic Surgeons - Specialists in musculoskeletal conditions who may perform carpal tunnel release
3. Plastic Surgeons - Often perform hand surgeries including carpal tunnel release
4. Neurosurgeons - May perform carpal tunnel release, especially in complex cases

Non-Surgical Specialists

1. Neurologists - Assist with diagnosis through electrodiagnostic testing (EMG/NCS) 3
2. Rheumatologists - Manage underlying conditions that may cause carpal tunnel syndrome
3. Physical Medicine & Rehabilitation (PM&R) Physicians - Provide conservative management options
4. Occupational Therapists - Implement splinting, exercises, and ergonomic modifications 1

Diagnostic Collaboration

Different specialists may be involved in the diagnostic process:

• Radiologists - Perform and interpret imaging studies:
  • Ultrasound has high sensitivity and specificity for diagnosis 2, 1
  • MRI without contrast can diagnose CTS with high accuracy 2
• Neurologists - Conduct electrodiagnostic studies to confirm diagnosis and assess severity

Treatment Decision Making

Conservative Management (Non-Surgical)

• Typically initiated by primary care providers or non-surgical specialists
• Includes:
  • Splinting (especially at night) 1
  • Activity modification 1
  • Physical/occupational therapy 1
  • Local corticosteroid injections (resolving symptoms in ~61% of cases) 1

Surgical Management

• Indicated when:
  • Conservative treatment fails after 2-7 weeks 4
  • Evidence of median nerve denervation 4
  • Patient preference after discussion of options 4
• Surgical options include:
  • Open carpal tunnel release
  • Endoscopic carpal tunnel release
  • Both techniques are equally effective 1

Common Pitfalls to Avoid

• Delayed referral to specialists - Early surgical intervention may be appropriate with evidence of nerve denervation 4
• Overreliance on imaging - Clinical assessment remains the cornerstone of diagnosis
• Continuous daytime splinting - Can lead to muscle deconditioning 1
• Inadequate follow-up - Regular monitoring is crucial to prevent long-term complications 1
• Failure to consider underlying conditions - Systemic conditions like rheumatoid arthritis may require specific management 1

Key Takeaway

While primary care physicians can manage initial conservative treatment, surgical specialists (particularly hand surgeons) are the most appropriate physicians for definitive treatment of carpal tunnel syndrome that requires surgical intervention. The choice between conservative and surgical management should be based on symptom severity, duration, and response to initial treatment.