How Neurologists Diagnose and Treat Carpal Tunnel Syndrome

Do you struggle to grip objects, make a tight fist, feel pins and needles in your fingers, or notice weakness or numbness in your wrist or hand? You may have carpal tunnel syndrome (CTS). This common condition affects millions of Americans and can interfere with everything from typing at work to holding a coffee cup.[1]

If you’ve been living with hand or wrist pain, a specially trained neurologist can identify and treat CTS and help prevent long-term nerve damage.

Let’s review what carpal tunnel is, how neurologists diagnose it and what you can expect during treatment.

A Quick Look at Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) happens when the median nerve, which runs from your forearm into your palm, becomes compressed at the natural arch of your wrist. [2] The carpal tunnel is a narrow passageway formed by ligaments and bones. When it gets crowded by swelling, the nerve is squeezed, leading to symptoms such as:

• Tingling or numbness in the thumb, index, middle, or part of the ring finger [3]
• Hand weakness, especially when gripping objects [4]
• Burning or shock-like sensations that may travel up the arm [5]

CTS often occurs during pregnancy or in people with diabetes, hypothyroidism, arthritis or whose work or sport requires repetitive movements.[6]

How Neurologists Diagnose Carpal Tunnel Syndrome

Although carpal tunnel syndrome affects the wrist, it’s a neurological condition whose symptoms often overlap with other nerve and musculoskeletal problems, so an accurate diagnosis is essential. Neurologists specialize in the nervous system; their expertise in peripheral nerve testing and interpretation makes them the ideal clinicians to diagnose and treat CTS.

Your neurologists will follow a step-by-step approach:

STEP 1: Medical History and Symptom Review

Your neurologist will ask when symptoms began, what activities make them worse, and whether they affect both hands. CTS often develops gradually, with patients noticing nighttime symptoms first, including numbness and the need to “shake it out”.[4]

STEP 2: Physical Examination

Neurologists perform simple in-office tests such as:

• Carpal compression test: considered most effective for diagnosing CTS. Uses constant pressure for 30 seconds directly over the carpal tunnel. [7]
• Tinel’s sign: gently tapping the median nerve at the wrist to see if tingling occurs. [5]
• Phalen’s test: bending the wrist forward to check if symptoms are triggered.[4]

STEP 3: Nerve and Muscle Testing

The gold standard for confirming CTS is nerve conduction studies and electromyography (EMG). These tests measure how well electrical signals move through the median nerve and muscles. [8] They help neurologists rule out other conditions like peripheral neuropathy or cervical spine disorders.[9]

Nerve conduction studies are used along with EMGs to stimulate the nerve and record its responses. Slowed responses indicate that the electrical impulses are taking too long due to compression.[10]

STEP 4: Imaging, When Needed

While not always necessary, ultrasound or MRI may be used to check for structural problems or other contributing factors in the wrist.[11]

Treatment Options for Carpal Tunnel Syndrome

Treatment depends on the severity of your symptoms and how long you’ve had them. Neurologists typically recommend a stepwise approach, starting with the least invasive methods first.

Non-Surgical CTS Treatments

• Wrist splints: Wearing a brace at night keeps the wrist straight, reducing pressure on the median nerve [5]
• Activity modification: Adjusting hand movements, positioning and taking breaks from repetitive tasks helps prevent flare-ups [4]
• Medications: NSAIDs or corticosteroid injections can reduce inflammation and swelling around the nerve [11]
• Physical therapy and nerve gliding exercises: These can improve flexibility and reduce nerve irritation [12]

Does My Carpal Tunnel Require Surgery?

No, not if your pain and symptoms are improving. But if conservative treatment hasn’t helped, or if nerve tests show severe compression, your neurologist may recommend carpal tunnel release surgery. [5]. The good news is that this procedure is highly effective.[7] It works by cutting the ligament that’s pressing on the nerve, which relieves pressure and restores normal function. [2] Your doctor will help decide which option is best for you—open surgery or an endoscopic procedure that uses a smaller incision and a camera [2]

Avoid a Delay in Healing a Head Injury: Consult a Neurologist for Concussion Recovery

Many people try to “tough it out” or assume their wrist pain is just a minor strain. But untreated carpal tunnel syndrome can lead to permanent nerve damage and muscle weakness.[5] Neurologists have specialized training in the nervous system, which allows them to distinguish CTS from other conditions that can look similar—such as arthritis, diabetic neuropathy, or pinched nerves in the neck.

By seeking care early, you’ll have the best chance of protecting nerve function, relieving symptoms, and avoiding long-term complications.

Is That Nighttime Wrist and Hand Numbness Actually Carpal Tunnel Syndrome?

Don’t ignore tingling, numbness, or weakness in your hands—especially if it wakes you at night. Neurologists have the expertise to find out if carpal tunnel is the cause and guide you toward lasting relief. The sooner CTS is diagnosed, the easier it is to treat, so you can get back to doing what you love, pain-free.

Disclaimer: This blog is intended for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician, neurologist, or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Do not disregard professional medical advice or delay seeking it because of something you read on this blog.

Resources:

1. Berg S. What doctors wish patients knew about carpal tunnel syndrome. American Medical Association (AMA) [Internet]. October 13, 2023. Accessed September 9, 2025. Available from: https://www.ama-assn.org/public-health/prevention-wellness/what-doctors-wish-patients-knew-about-carpal-tunnel-syndrome
2. Wilson TJ, Shuer LM. Carpal Tunnel Syndrome. American Association of Neurological Surgeons (AANS) [Internet]. Published April 26, 2024. Accessed September 9, 2025. Available from: https://www.aans.org/patients/conditions-treatments/carpal-tunnel-syndrome/
3. Mayo Clinic Staff. Carpal tunnel syndrome. Mayo Clinic. Published February 6, 2024. Accessed September 9, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/symptoms-causes/syc-20355603
4. Goerl K, Wipperman J. Carpal Tunnel Syndrome: Diagnosis and Management. Am Fam Physician [Internet]. 2016;94(12):993-999. Accessed September 9, 2025. Available from: https://www.aafp.org/pubs/afp/issues/2016/1215/p993.html
5. Carpal Tunnel Syndrome. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published December 18, 2023. Accessed September 9, 2025. Available from: https://www.niams.nih.gov/health-topics/carpal-tunnel-syndrome/diagnosis-treatment-and-steps-to-take
6. Steinberg DR. Carpal Tunnel Syndrome. Merck Manual Consumer Version [Internet]. Accessed September 9, 2025. Available from: https://www.merckmanuals.com/home/bone-joint-and-muscle-disorders/hand-disorders/carpal-tunnel-syndrome
7. Sevy JO, Sina RE, Varacallo MA. Carpal Tunnel Syndrome. [Updated 2023 Oct 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Accessed September 9, 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448179/#
8. EMG (Electromyography). Cleveland Clinic [Internet]. Accessed September 9, 2025. Available from: https://my.clevelandclinic.org/health/diagnostics/4825-emg-electromyography
9. Carpal tunnel syndrome | Handouts. MedLink Neurology [Internet]. Published 2023. Accessed September 9, 2025. Available from: https://www.medlink.com/handouts/carpal-tunnel-syndrome
10. Saggar SK, Thaman RG, Mohan G, Kumar D. Mapping Neurophysiological Patterns in Carpal Tunnel Syndrome: Correlations With Tinel’s and Phalen’s Signs. Cureus. 2024;16(4):e58168. Published 2024 Apr 13. doi:10.7759/cureus.58168 Accessed September 9, 2025. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11089430/#
11. Mayo Clinic Staff. Carpal tunnel syndrome – Diagnosis and treatment. Mayo Clinic [Internet]. Published February 6, 2024. Accessed September 9, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/diagnosis-treatment/drc-20355608
12. Zhang D, Chruscielski C, Blazar P, Earp B. Accuracy of Provocative Tests for Carpal Tunnel Syndrome. Journal of Hand Surgery Global Online [Internet]. 2020;2(3):121-125. doi:https://doi.org/10.1016/j.jhsg.2020.03.002 Accessed September 9, 2025. Available from: https://www.sciencedirect.com/science/article/pii/S2589514120300189#