Who Performs a Carpal Tunnel Workup
The carpal tunnel workup is primarily performed by primary care physicians, with referral to hand surgeons or orthopedic surgeons when surgical intervention is being considered. 1
Initial Evaluation Provider
- Primary care physicians conduct the initial diagnostic workup, which includes clinical evaluation combined with electrophysiologic studies 1
- The diagnosis is primarily clinical, based on characteristic symptoms (pain, numbness, tingling in median nerve distribution) and provocative tests 2
- Electrophysiologic testing (electroneuromyography) confirms the diagnosis and establishes severity 1, 2
When to Involve Specialists
Hand Surgeons or Orthopedic Surgeons
- Referral to surgeons is appropriate when conservative management fails or when moderate to severe disease is present 1
- Surgical decompression provides the strongest evidence base among common orthopedic procedures and is the most effective treatment for moderate to severe carpal tunnel syndrome 3
- Surgeons perform the definitive treatment (open or endoscopic carpal tunnel release) 1
General Practitioners with Special Interest (GPwSI)
- In some healthcare systems, GPwSI in Surgery may perform carpal tunnel decompression in primary care settings 3
- This represents a migration of minor surgical procedures from hospitals to community settings 3
Imaging Specialists (When Needed)
- Radiologists perform and interpret imaging studies when clinical diagnosis is unclear 3, 1
- Ultrasound can measure median nerve size and is highly sensitive and specific for diagnosis 1
- MRI without contrast may be appropriate in selected circumstances with unclear diagnoses 1
Important Clinical Pitfall
Do not proceed directly to surgery without attempting conservative management (nighttime wrist splinting, corticosteroid injection) in patients with mild to moderate disease, as 48-63% will respond to conservative measures 1