• Numbness/tingling in the thumb–index–middle fingers (often worse at night)

• Achy base-of-thumb pain with pinch or opening jars

• Sharp wrist pain with lifting, typing, or twisting (door knobs, jars)

• Pain at the elbow that radiates to the forearm/wrist with gripping

• Burning or electric sensations consistent with nerve irritation

• Focused exam to isolate nerve vs tendon vs joint

• X-ray (thumb CMC arthritis, fractures); ultrasound (tendons, cysts)

• EMG/Nerve conduction studies when neuropathy or nerve compression is suspected

• Selective diagnostic injections (numbing medicine) to confirm the pain generator

Conservative first

• Splints/braces (night wrist splint for carpal tunnel; thumb CMC brace)

• Targeted hand therapy (mobility, tendon glides, eccentric loading)

• Ergonomic tweaks and pacing strategies

• Medications when appropriate (acetaminophen; short NSAID courses; neuropathic agents if indicated)

Image-guided options (case-by-case)

• Carpal tunnel injection to calm median nerve inflammation

• Tendon-sheath or bursal injection for De Quervain’s/trigger finger

• PRP for select tendinopathies (case-by-case)

• Peripheral nerve blocks for refractory nerve pain patterns

Surgical referral

• When structural release/repair is clearly the best option (e.g., carpal tunnel release, trigger finger release)