What is carpal tunnel syndrome?
Carpal tunnel syndrome is a pinched nerve at the wrist that causes hand pain and numbness. It can make sleep, grip strength, and everyday tasks like typing or cooking much harder.
Living with carpal tunnel syndrome
Carpal tunnel syndrome often starts as tingling or numbness in the thumb, index, and middle fingers, especially at night. You might wake up shaking your hand out, or feel burning or pins and needles when you hold a phone, drive, or type. Over time, you may notice clumsiness, dropping objects, or weakness when you pinch or open jars.
Carpal tunnel syndrome is common in adults, affecting an estimated 3 to 5 percent of people, and is more frequent in women and in midlife. ¹ ² It is also a major cause of work difficulty and job changes in people who use their hands a lot. ² ³ The good news is that many people improve with simple steps such as night splints, activity changes, and in some cases a steroid injection. For those with more severe or persistent symptoms, surgery is usually highly effective at relieving pressure on the nerve. ¹ ³ ⁷ ⁸
What are the symptoms of carpal tunnel syndrome?
Common symptoms of carpal tunnel syndrome include:
- Tingling, pins and needles, or numbness in the thumb, index, middle, and ring finger on the thumb side
- Symptoms worse at night, often waking you from sleep and eased by shaking or hanging the hand down
- Tingling or numbness during activities like driving, reading, holding a phone, cycling, or typing
- Aching or burning in the wrist, palm, or forearm
- Feeling clumsy or weak, dropping objects, or struggling with fine tasks like doing up buttons
- Pain that can travel up the forearm toward the elbow
- In more advanced cases, visible thinning of the thumb muscles at the base of the thumb and difficulty with thumb opposition or strong pinch
Red flag features that need prompt review:
- Constant numbness rather than off-and-on tingling
- Noticeable weakness of the thumb or visible muscle wasting in the palm
- Very rapid worsening symptoms
- New symptoms after a wrist fracture or crush injury could mean a possible acute carpal tunnel syndrome, which is a rare form with rapid progressive course and high potential for permanent changes in nerves and muscles
These signs should prompt urgent assessment by a clinician and often early nerve tests and surgical review. ¹ ² ⁴
Did you know?
Night splints really can make a difference. Research shows that wearing a neutral wrist splint at night for mild to moderate carpal tunnel syndrome improves symptoms more than doing nothing, and is safe and low cost. ⁷ ⁹
What causes carpal tunnel syndrome?
The carpal tunnel is a narrow passage at the wrist that contains the median nerve and several tendons. Anything that reduces the space in this tunnel, or increases pressure within it, can squeeze the nerve. Over time, this can affect how the nerve carries signals, causing tingling, pain, and weakness.
Factors that increase the chance of carpal tunnel syndrome include:
Body and health factors
- Being female and in midlife
- Smaller wrist or carpal tunnel dimensions
- Pregnancy and fluid retention
- Perimenopause and hormone changes
- Diabetes, obesity, metabolic syndrome (high blood pressure, high blood sugar, too much fat around the waist and high cholesterol)
- Thyroid disease and inflammatory arthritis (joint inflammation caused by an overactive immune system) such as rheumatoid arthritis ¹ ² ³ ¹³
Structural and injury-related factors
- Past wrist fracture or malalignment, especially distal radius malunion
- Swelling from tenosynovitis or inflammatory conditions in the tunnel
Work and activity factors
- Jobs with forceful, repetitive hand use, such as using tools, gripping, or squeezing
- Tasks with prolonged wrist bending, either up or down
- Hand–arm vibration exposure, for example using powered tools for long periods ¹ ³ ¹⁴
Often no single cause is found. Instead, several of these factors combine to increase pressure on the median nerve over time.
When should I see a doctor for carpal tunnel syndrome?
You should book a medical review if:
- Tingling, numbness, or pain in your hand has lasted more than a few weeks
- Symptoms are waking you at night on most nights
- You are dropping objects or notice clumsiness in your hand
- Symptoms are on both sides, or you have other nerve symptoms in the legs or other body areas
These features can mean the nerve is more severely affected or that another condition is present, and early nerve testing and surgical review may be needed. ¹ ² ⁴
Seek a doctor right away if you notice:
- You have constant numbness that does not come and go
- You notice weakness of the thumb, difficulty moving the thumb, or muscle wasting at the base of the thumb
- Symptoms start suddenly or worsen quickly after wrist trauma, such as a fracture
- You have unexpected symptoms, or feel unwell or have other nerve problems, such as speech or vision changes
How is carpal tunnel treated?
Most people with whiplash recover with simple measures, education, and active rehabilitation. Early movement and reassurance are now preferred over collars and long periods of rest. ² ³ ⁴ ¹⁰ ¹¹
Key parts of care include:
Education and activity changes
- Keeping the wrist close to neutral, especially at night
- Avoiding long periods of strong gripping, repetitive force, or deep wrist bending if possible
- Taking regular breaks from hand-intensive tasks
- Working on general health, including weight management and good diabetes or thyroid control when relevant ¹ ² ³
Splinting
- A neutral wrist splint worn at night is a common first step for mild to moderate carpal tunnel syndrome
- Many people notice less waking at night and less tingling within 2 to 6 weeks
- Splints can be off the shelf or custom; the key is that the wrist is in a neutral, comfortable position ⁷ ⁹
Corticosteroid injection
- A steroid injection into the carpal tunnel can reduce swelling and pressure around the nerve and often gives stronger short-term relief than splints
- A large trial from the United Kingdom found that at 6 weeks, people who had a single injection had better symptom relief than those using a night splint, but over the long term many people had symptoms return and later chose surgery ⁷ ⁸
- Injections are often used when symptoms are troublesome and splints alone are not enough, or when a short-term boost is needed, for example during pregnancy
Exercises and physical therapy
- Nerve and tendon gliding exercises to improve movement of the median nerve and tendons in the tunnel
- Gentle stretching and strengthening of the hand, forearm, and shoulder girdle
- Swelling management techniques and ergonomic coaching for work and home tasks
- Exercises are usually used as an add-on to splints and activity changes, and can give small to moderate symptom improvements in some people ⁷ ⁹ ¹⁰
Surgery
Carpal tunnel release surgery is considered when:
- Good quality non-surgical care over several weeks to months has not improved symptoms enough
- There is weakness of the thumb or clear muscle wasting
- Nerve tests show severe nerve conduction changes
- There is acute carpal tunnel syndrome after trauma
In surgery, the ligament that forms the roof of the tunnel is cut to relieve pressure on the nerve. This can be done through a small open incision or using an endoscope. Both methods are effective and have similar long-term outcomes. ³ ¹⁰ ¹¹
- Open surgery is simple and widely available, but recovery can involve more early scar tenderness and pain
- Endoscopic release often allows faster early recovery and return to work, but may temporarily irritate the nerve more frequently ¹⁰ ¹¹ ¹²
Most people have significant symptom relief after surgery, especially when the nerve has not been severely damaged for a very long time. ³ ¹⁰ ¹¹ ¹²
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