A 45-year-old seamstress presents to the clinic with a 4-year history of paresthesias of the volar right thumb, index, and middle finger with associated pain. She reports that the symptoms are worse at night. She has no past medical history and no history of cancer. On examination, she has decreased sensation on the volar thumb, index, and middle finger as well as the dorsal fingertips and a positive Tinel’s sign and Phalen’s test at the wrist. Strength in her abductor pollicis brevis is abnormal at 3/5 compared to the contralateral side. She has moderate thenar atrophy but no hypothenar or intrinsic muscle atrophy. The hand is well perfused. There are no surgical or traumatic scars on the hand or wrist. Bilateral radial and ulnar pulses are normal.