If you're waking up at night shaking out a numb, tingling hand — or dropping your phone, your coffee, your keys — that's the median nerve asking for help. We diagnose carpal tunnel the same day and build a plan that fits your hands, your work, and your life.
Conservative care, injections, and endoscopic release at LAOSS.
Carpal tunnel syndrome is one of the most common nerve problems in the body — and one of the most misunderstood. Patients often think it's a tendon problem or a wrist injury. It isn't. It's a nerve being squeezed in a tight space.
The carpal tunnel is a narrow passageway on the palm side of your wrist, about the width of your thumb. The floor and walls are made of small wrist bones; the roof is a tough band of tissue called the transverse carpal ligament. Through this tunnel run nine flexor tendons (the ones that bend your fingers) and the median nerve, which carries sensation to your thumb, index finger, middle finger, and half of your ring finger.
When the tissue inside the tunnel swells — from repetitive hand use, fluid shifts during pregnancy, inflammation from diabetes or thyroid disease, or just an anatomically tight tunnel — the median nerve gets pinched against the ligament above it. The nerve responds the way any nerve does under pressure: numbness, tingling, burning, and eventually weakness.
At LAOSS, the most common carpal tunnel patients we see are office workers in their 30s through 60s, pregnant women in their second and third trimesters, and manual laborers with high-repetition jobs. Most of them improve with conservative care: a properly fitted night splint, ergonomic changes, anti-inflammatories, and — when needed — a single corticosteroid injection. When those don't hold, endoscopic carpal tunnel release is one of the most reliable procedures in orthopedics, performed wide-awake through a small incision, with patients driving home an hour later.
Pain, numbness and tingling in your hand may be from carpal tunnel syndrome. It happens when the area around the main nerve to your hand is too tight. The nerve is called the median nerve. And the small space in your wrist where it passes is called the carpal tunnel.
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The carpal tunnel is roofed by the transverse carpal ligament and floored by the small carpal bones of the wrist. Any swelling inside this fixed space — from inflamed tendon sheaths, fluid retention, or anatomic crowding — compresses the median nerve, producing the classic thumb/index/middle-finger numbness that defines this condition.
Carpal tunnel can usually be diagnosed in a single visit, but the goal isn't just to confirm it — it's to rule out the things that mimic it. Cervical (neck) nerve compression, ulnar nerve issues at the elbow, thoracic outlet syndrome, and early peripheral neuropathy can all feel similar. The wrong diagnosis means the wrong treatment.
Your LAOSS evaluation starts with a focused history: when symptoms began, which fingers are involved, what makes them worse, whether they wake you at night, and what you do for work or hobbies. Then a hands-on exam — Tinel's sign (tapping over the nerve), Phalen's test (holding the wrists in flexion), thumb-pad strength, and two-point sensory discrimination. Together these are over 85% accurate for classic carpal tunnel.
When the picture isn't clear-cut, or when surgery is on the table, we order nerve conduction studies (NCS) and electromyography (EMG). These measure how fast the median nerve transmits a signal across the wrist and whether the muscles it controls are getting their messages. Ultrasound of the wrist is also useful — it can show a swollen median nerve and rule out a mass inside the tunnel.
Most LAOSS patients leave the first visit with a clear diagnosis, a graded severity (mild, moderate, or severe), and a written plan. That's the point of the visit — not another referral.
Carpal tunnel doesn't have to mean surgery — and even when it does, the procedure is one of the fastest, most reliable in orthopedics. We start with the least-invasive option that fits your severity and escalate only when it doesn't hold. Here's the full menu.
For mild-to-moderate carpal tunnel, non-surgical care resolves symptoms in the majority of patients — especially when started early.
When numbness becomes constant, grip weakens, EMG shows nerve damage, or conservative care fails — carpal tunnel release is straightforward and highly effective.
Carpal tunnel release looks simple on paper, but the difference between a great outcome and an incomplete one comes down to identifying the right diagnosis, releasing the ligament completely, and protecting the nerve and its branches.
Our hand specialists move stepwise — splint first, inject when appropriate, release when nothing else holds. Most patients never need the OR.
If most of these match your situation, an evaluation with a hand specialist is the next step.
These signs typically point toward an in-person evaluation with a hand and wrist specialist.
Your first visit is built to give you an answer the same day, not another referral.
Carpal tunnel release recovery is one of the fastest in orthopedics — but using the right milestones matters. Here's what most patients can expect after endoscopic release.
In the first week the focus is protecting the small incision, keeping the hand elevated, and starting gentle finger motion immediately.
Strength rebuilds quickly, but the palm can feel tender (pillar pain) for several weeks — this is normal and resolves.
Most patients regain full grip strength and lose night-time numbness completely. Long-standing nerve damage may improve more slowly.
Carpal tunnel release has one of the highest patient-satisfaction rates in all of orthopedics — but it's still surgery. We talk through the risks and benefits with every patient.
Every surgical intervention carries a small set of standard risks. We screen, prepare, and monitor for these on every patient.
Some risks are specific to working around the median nerve and the structures of the wrist. We discuss these in detail so you can weigh them against the benefits.
Hand surgery is its own world. The anatomy is small, the nerves are unforgiving, and a millimeter of technique decides whether you can text again at week two or week six. At LAOSS, carpal tunnel patients are evaluated and treated by fellowship-trained hand and upper-extremity surgeons — not general orthopedists who occasionally do wrists.
Our hand team performs endoscopic and open carpal tunnel release as outpatient procedures, often wide-awake under local anesthesia only — no IV, no general anesthesia, and most patients drive themselves home within an hour. From your first evaluation through the last follow-up, you'll work with the same specialist who actually performs your procedure.
5 stars all around. Got referred here for carpal tunnel. Dr. Malafa did the release wide-awake — no IV, drove myself home in an hour. Mind blown.
If you're waking up shaking out your hand, book a same-day visit with a hand specialist at any of our eight Los Angeles–area offices.
