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I am planning to see an orthopedic surgeon on the recommendation of my family practice nurse for what might be carpal tunnel syndrome. What should I expect?

In order to ensure consistent results for all patients with various conditions like carpal tunnel syndrome, clinical practice guidelines are published. Organizations like the American Academy of Orthopaedic Surgeons review the literature and summarize findings based on current evidence available. Physicians are advised to follow these guidelines in caring for patients with the specified condition. In the case of carpal tunnel syndrome, you can expect your physician to start by getting an accurate patient history. Questions should be asked about the symptoms (e.g., duration, severity, location). Previous treatment, lifestyle and activities, and any limitations in function due to symptoms are also recorded. An exam comes next. The physical exam should include age, gender, weight and height, and range-of-motion and strength of the wrist and hand. Special tests for sensation, vibration, nerve irritation can be performed. Any obvious muscle atrophy (wasting) or other deformities should be noted. There are a variety of tests physicians already use to help identify the presence of carpal tunnel syndrome (e.g., Phalen's, Tinel's, reverse Phalen). Electrodiagnostic tests are ordered for certain patients. Anyone with persistent numbness and/or who has muscle wasting of the thumbpad should have nerve conduction velocity (NCV) and electromyography (EMG) done. Both of those symptoms suggest severe nerve injury. Once this has been confirmed, then treatment can be determined. NCV and EMG have been able to sort out carpal tunnel from other nerve problems. Feel free to ask whomever you see what his or her standard protocol is for the evaluation of carpal tunnel syndrome. If you have questions about anything included (or not included), don't hesitate to ask. Early diagnosis and a plan of care based on the examination findings is the key to fast and successful treatment results.

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