Our Specialists for Carpal Tunnel Syndrome
Carpal tunnel release is one of the most common operations in the hand, but small technical decisions at the wrist have big consequences for pain, recovery, and recurrence. Our peripheral nerve team performs both open and endoscopic release and tailors the approach to your anatomy and your work.
Dr. Choudhri is Director of Innovation in the Department of Neurological Surgery at UChicago. He leads departmental efforts to translate new technologies and surgical techniques into patient care across the neurosurgical service. As Director of Innovation in the Department of Neurological Surgery, Dr. Choudhri offers both open and endoscopic carpal tunnel release at UChicago and will walk you through which approach fits your anatomy and your work. If you have a straightforward carpal tunnel problem, he is one of the surgeons who can have you back to normal activity within a couple of weeks.
Dr. Raksin is an Associate Professor of Neurological Surgery and serves as Associate Program Director of the UChicago Neurological Surgery residency program. She is a senior clinician within the department and contributes broadly to resident education and general neurosurgical care. Dr. Raksin is a senior peripheral nerve and general neurosurgeon at UChicago who evaluates carpal tunnel patients on a regular basis, including complex cases with a previous release, unusual anatomy, or overlapping cervical nerve root problems. If your picture is not a clean textbook case, she is a good person to have sort it out.
What Is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passage on the palm side of your wrist. The floor and walls are formed by the small bones of your wrist, and the roof is a tough band of tissue called the transverse carpal ligament. Nine finger tendons and one important nerve — the median nerve — all share this tight space.
When pressure inside the tunnel goes up, the median nerve gets squeezed. The nerve does not like being compressed, and it starts to misfire. That is what produces the familiar symptoms of carpal tunnel syndrome (CTS): numbness, tingling, and pain in the hand, usually worst at night.
Carpal tunnel syndrome is the most common nerve compression problem in the body. It affects roughly 3-5% of adults in the general population and is more common in women, during pregnancy, and in people with diabetes, thyroid disease, or rheumatoid arthritis. It is also more common in people who do a lot of forceful or highly repetitive hand work, though many patients have no obvious trigger at all.
At a Glance
- Carpal tunnel syndrome is caused by pressure on the median nerve as it passes through a tight tunnel at the base of your palm
- It is the most common entrapment neuropathy, affecting roughly 3-5% of adults
- Classic symptoms are night-time numbness and tingling in the thumb, index, and middle fingers
- Night splints and a steroid injection can calm mild cases, but benefit is often short-lived
- Carpal tunnel release surgery is safe, brief, and highly effective, with most patients back to light activity within 1-2 weeks
Have imaging or a diagnosis already?
We'll have a specialist review your MRI and records — often within 24 hours.
What Does It Feel Like?
Carpal tunnel symptoms almost always follow a recognizable pattern. The median nerve supplies sensation to the thumb, index finger, middle finger, and half of the ring finger — so that is where you feel it.
Early symptoms
- Numbness or tingling in the thumb, index, and middle fingers
- Symptoms that wake you up at night and make you shake out your hand
- Numbness when driving, holding a phone, or reading a book
- A feeling that your hand is asleep or on fire
- Dropping small objects like keys or coins
Later symptoms
- Constant numbness, even during the day
- Weakness when pinching or gripping
- Loss of muscle bulk at the base of the thumb (the thenar eminence)
- Clumsiness with buttons, zippers, and jar lids
One important clue: carpal tunnel syndrome does not usually cause pain or numbness in the little finger. The little finger is supplied by a different nerve (the ulnar nerve). If your little finger is numb too, something else may be going on, and we will look carefully at your elbow and neck.
How Is It Diagnosed?
The diagnosis starts with your story and a careful hand exam. Most of the time, the history alone makes us strongly suspect carpal tunnel syndrome before we have touched your wrist.
Physical exam
We will test sensation in each finger, check the strength of the muscles at the base of your thumb, and perform a few provocative tests:
- Tinel's sign: tapping over the median nerve at the wrist to see if it reproduces tingling in your fingers
- Phalen's test: flexing your wrists for about a minute to see if it brings on numbness
- Carpal compression test: gentle pressure on the carpal tunnel to see if symptoms come on
Nerve conduction studies and EMG
If the diagnosis is uncertain, or if you are considering surgery, we usually order nerve conduction studies (NCS) and sometimes an electromyogram (EMG). These tests measure how quickly electrical signals travel down the median nerve and whether the muscles it supplies are getting the right signals. They tell us how severely the nerve is compressed and help rule out other problems like a pinched nerve in the neck.
Imaging
Plain X-rays, ultrasound, or MRI are not needed in most cases, but ultrasound can be useful when we suspect a mass, cyst, or unusual anatomy inside the tunnel. If your exam suggests the problem might be in your neck or elbow, we may order additional imaging of those areas.
How Is It Treated?
Treatment depends on how severe your symptoms are, how long you have had them, and whether the nerve has started to lose function. Mild cases often get better with simple measures. More severe cases, and any case with muscle weakness or constant numbness, usually do best with surgery.
Night splinting
A neutral wrist splint worn at night is the first step for most people with mild or early symptoms. It keeps the wrist from curling into the positions that pinch the nerve while you sleep. Splinting does not fix the underlying anatomy, but it can meaningfully reduce symptoms and, for some people, is all they need. The 2024 AAOS/ASSH clinical practice guideline supports splinting as a reasonable first-line treatment for mild to moderate disease.
Steroid injection
A steroid injection into the carpal tunnel can reduce swelling around the nerve and provide relief. The catch is that the benefit is usually temporary — weeks to a few months — and symptoms often come back. An injection is most useful as a short-term bridge, a diagnostic test when the picture is unclear, or a way to get someone comfortable through a pregnancy or a busy work stretch before surgery.
Open carpal tunnel release
Open carpal tunnel release is the gold standard operation for CTS. It is done through a small incision (typically 2-3 cm) in the palm. Through that incision we divide the transverse carpal ligament — the roof of the tunnel — which immediately takes pressure off the median nerve. The ligament heals back longer and looser, and pressure inside the tunnel drops and stays down.
The operation takes about 10-15 minutes and is usually done in an outpatient surgery center under local anesthesia with light sedation. You go home the same day with a soft dressing, and you can use your hand for light activity right away. Most patients notice that the night-time numbness is gone the first night after surgery.
Endoscopic carpal tunnel release
In endoscopic carpal tunnel release, the same ligament is cut, but through one or two tiny incisions using a small camera. The end result inside the wrist is the same — the transverse carpal ligament is divided — but the skin incision is smaller and there is less tenderness in the palm in the first few weeks.
Randomized trials show that patients who have endoscopic release return to work on average about a week sooner and have less palm tenderness early on. By 3-6 months, long-term outcomes, grip strength, and symptom scores are essentially the same for the two techniques. Endoscopic release is a reasonable choice for many patients, but is not right for everyone — previous wrist surgery, unusual anatomy, or certain masses inside the tunnel are reasons to choose an open approach.
Which approach is right for me?
Honestly, in experienced hands, both operations work very well. We will walk you through the trade-offs and help you pick the approach that fits your anatomy, your job, and your preferences. The most important factor is not which technique you choose — it is that the ligament is completely released and the nerve is protected.
Considering surgery or planning a second opinion?
Our multidisciplinary team reviews complex cases together. You'll get a coordinated plan, not one opinion.
What Are the Outcomes?
Carpal tunnel release is one of the most reliable operations in all of surgery. The large majority of patients have significant, lasting relief of their night-time symptoms, and most get back to full activity within a few weeks.
| What to expect | Typical result | What to know |
|---|---|---|
| Symptom resolution | ~90% good or excellent relief | Night-time numbness usually resolves within days |
| Return to desk work | ~1-2 weeks | Slightly faster after endoscopic release |
| Return to manual labor | ~4-6 weeks | Depends on grip demands |
| Long-term recurrence | ~3-5% | Higher when severe nerve damage is present before surgery |
What affects the result?
Two things predict how much relief you will get: how severe the nerve compression was before surgery, and how long you had symptoms. Patients treated before the muscles at the base of the thumb have wasted, and before the numbness becomes constant, tend to have the best results. If the nerve has been severely compressed for years, some numbness or weakness may be permanent even after a technically perfect operation — which is why we do not recommend waiting until things get bad.
Complications
Serious complications from carpal tunnel release are rare. Minor issues like pillar pain (tenderness at the edges of the incision) are common in the first few weeks and almost always resolve. Infection, nerve injury, and incomplete release are uncommon, and are all lower in the hands of experienced surgeons.
References
Have Questions About Carpal Tunnel Syndrome?
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