Carpal Tunnel Syndrome

Carpal tunnel syndrome is a fairly common complaint, often associated with keyboarding and other activities that demand repetitive use of the wrist, hand and fingers. While the condition is not serious, it can be painful, making it difficult to perform everyday tasks. Carpal tunnel syndrome is most likely to appear in the dominant hand, but it may occur in either or both hands.

Carpal Tunnel Anatomy

The carpal tunnel is a narrow passageway formed by the carpal bones of the wrist and the transverse carpal ligament. The median nerve travels from the neck, down the arm, and passes through the carpal tunnel at the wrist on its way to the hand and fingers. The median nerve provides sensation in the thumb, index, middle, and ring fingers, and innervates the muscles at the base of the thumb. Nine flexor tendons that bend the fingers also pass through the carpal tunnel.

Because the tunnel is a relatively crowded space with rigid walls, inflammation of any tissues within the tunnel can put pressure on the median nerve and restrict its ability to glide.


Carpal Tunnel Symptoms

Symptoms of carpal tunnel syndrome include:

  • Pain, numbness or tingling in the thumb and fingers
  • Pain or numbness that travels up the arm
  • Weakened or clumsy hands
  • Pain at the base of the thumb

Carpal tunnel symptoms are often worse upon rising in the morning.

Carpal Tunnel Causes

Carpal tunnel causes may involve a combination of factors. Some of the most common causes include:

  • Anatomically narrow carpal tunnel due to genetics
  • Repetitive motion like keyboarding that overuses the flexor tendons
  • Excessive use of vibrating power tools
  • Hormonal fluctuations that cause fluid retention in the wrist and hand
  • A cyst or tumor in the tunnel
  • Certain medical conditions like diabetes, arthritis, and thyroid gland imbalances

Carpal Tunnel Syndrome Diagnosis


Because hand pain can be triggered by a number of factors, accurate diagnosis is key to appropriate treatment. At NYDNR, we use real-time diagnostic ultrasound to view the structures of the wrist and hand in motion, to zero in on the exact cause of pain. Once carpal tunnel syndrome is confirmed, we devise an individualized carpal tunnel treatment plan for each patient.


Please explore more advanced diagnostic option unavailable anywhere else:


Carpal Tunnel Syndrome Treatment

Traditional treatment for carpal tunnel syndrome often involves rest, splinting, NSAIDs, and steroid injections to reduce inflammation and ease pain. However, for patients whose occupation demands daily keyboarding or tool use, traditional pain management strategies may not be effective.

At NYDNR, we use the most innovative therapies and cutting edge technologies to promote carpal tunnel relief and restore pain-free function to your wrist and hand.

Treatment for carpal tunnel pain relief at NYDNRehab may include::

Ultrasound guided nerve hydro-dissection:

This minimally invasive treatment method is often used in conjunction with other therapies to release median nerve entrapment and restore blood supply to the hand.

Ultrasound guided dry needling (USGDN):

Using ultrasound elastography, we identify the location of trigger points and insert a dry needle that triggers a twitch response in the tight tissue, instantly relieving proximal and distal median nerve compression.

Neurodynamic nerve mobilization:

Nerve mobilization exercises help the median nerve to glide smoothly along its entire pathway.

Electromagnetic transduction therapy (EMTT):

EMTT uses pulsed electromagnetic fields (PEMFs) to deliver low frequency currents to the carpal tunnel region, to influence the firing patterns of the median nerve and relieve pain.

EMTT Extracorporeal shock wave therapy (ESWT):

Shock waves present a non-invasive treatment option to reduce pain and inflammation in affected tissues within the tunnel, reducing pressure on the median nerve.


Learn more about the efficacy of ESWT for carpal tunnel here:


Additional therapies may include acupuncture, myofascial release techniques, joint mobilization, and ligament strengthening exercises.


Additional therapies may include acupuncture, myofascial release techniques, joint mobilization and ligament-strengthening exercises.

Best Carpal Tunnel Doctor in NYC

If you suffer from ongoing wrist and hand pain and numbness, you may have carpal tunnel syndrome. The wrist and hand pain specialists at NYDNR understand how important full use and function of your hands can be.

We provide the most advanced clinically proven treatment options to accelerate healing and restore full function to your wrist, hand and fingers, so you can get on with your busy life.

Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika revolutionized foot and ankle care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with with gait and motion analysis technology. Dr.Kalika’s motion and gait analysis lab is the only private lab in the US that features research-grade technology found only at top research universities, made available to patients in his private clinic.

Our Specialists

HyunJu YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)
Dr. Christina Pekar DC
Dr. Michelle Agyakwah DC
Dr. Mikhail Bernshteyn MD (Internist)

Range of Available Unique Physical Therapy Treatments at Nydnrehab

Our Rewards

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018)At: Paris, France
Conference: 22nd European Congress of Physical and Rehabilitation Medicine (ESPRM 2020)At: Belgrade, Serbia
Carpal Tunnel Syndrome
The initial symptoms of weakness and paralysis of the fingers and the hands.

Causes of Carpal Tunnel Syndrome

Tingling is usually a sign of nerve injury. Nerves generally have two major functions. There are sensory nerves which sense information in the skin, and there are moto occur in people that use the computer frequently, use the cash register, or are involved in activities that involve repetitive motion at the wrist. There is greater frequency of carpal tunnel syndrome among post-menopausal women.


The diagnosis of carpal tunnel syndrome is made using a nerve test called EMG/Nerve conduction study. Since there are multiple other causes of hand tingling, nerve testing is crucial toms could progress and become permanent.


Once the diagnosis of carpal tunnel syndrome is made we will determine the best possible treatment for the patient trying to our attention the chances of recovery are less, the patient could develop permanent paralysis, and surgical procedures might be required even though they could have been avoided early in the disease course. Patients with carpal tunnel syndrome could have full recovery with minimal intervention if they seek medical attention and treatment early.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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