Diagnosis & treatment of carpal tunnel syndrome
Most of the time, diagnosis starts with your story. A clinician will ask where you feel tingling or numbness, when it happens (often at night or with activities like driving or typing), and how it is affecting your sleep, grip, and daily tasks.¹ ²
They will also ask about things that can raise risk or change the plan, like pregnancy, diabetes, thyroid disease, inflammatory arthritis, and past wrist injuries.¹ ²
How do clinicians diagnose carpal tunnel syndrome?
During the exam, clinicians usually check:
- Which fingers feel numb or tingly, and whether symptoms match the median nerve pattern.¹ ²
- Strength and coordination, especially pinch strength and thumb control. Weakness or visible thinning at the base of the thumb can suggest a more advanced case.¹ ²
- Simple wrist tests that try to reproduce symptoms (for example, bending the wrist or gently tapping over the nerve). These tests can support the diagnosis, but they are not perfect on their own.¹ ²
When are nerve tests or ultrasound used?
Carpal tunnel syndrome is often diagnosed clinically, but testing can be helpful in specific situations.¹ ³Clinicians may recommend nerve conduction studies, sometimes paired with needle electromyography, when:
- the diagnosis is unclear or symptoms are atypical
- symptoms are severe, constant, or progressing
- there is weakness or muscle wasting
- surgery is being considered, or documentation is needed for work-related cases¹³
Some clinicians also use ultrasound to look at the median nerve and nearby structures, especially if they suspect a structural cause or want additional confirmation.¹
Clinical insight
What are the treatment options for carpal tunnel syndrome?
Treatment is usually chosen based on how intense symptoms are, how long they have been present, and whether there are signs of nerve damage. Many people start with conservative care, and surgery is typically reserved for cases that do not improve enough or show more serious nerve involvement.¹²
Education and early activity
Common first steps include reducing positions and tasks that repeatedly aggravate symptoms, and finding more neutral wrist setups for sleep and daily activities.¹²
Night splinting
A neutral-position wrist splint worn at night is a common starting option for mild to moderate symptoms. Evidence supports splinting compared with no treatment, and it is generally safe and low-cost.⁴
Corticosteroid injection
A single corticosteroid injection can improve symptoms faster than splinting for many people in the short term. In a large primary-care trial, injection provided better symptom relief at around 6 weeks than a night splint.⁵Longer-term follow-up suggests that symptom differences tend to narrow over time, and many people still consider surgery later depending on how symptoms evolve.⁶
Exercise-based rehabilitation
Exercise-based care, including guided movement and strengthening, is often used alongside splinting and activity changes. Some people also use nerve and tendon gliding exercises as part of a broader plan. Evidence varies across approaches, so these are typically used as supportive options rather than stand-alone fixes for more severe compression.¹²
Surgery
Carpal tunnel release is usually considered when:
- symptoms remain function-limiting after a trial of high-quality non-surgical care
- there is thumb weakness or thenar muscle wasting
- nerve testing shows more severe changes, or symptoms are rapidly worsening¹²³
Both open and endoscopic approaches can work well, with broadly similar long-term outcomes. Some evidence suggests faster early recovery with endoscopic techniques, while open surgery is widely available and effective.⁷
Sword's approach
Sword Health helps people manage pain and movement issues with expert-guided AI care you can use from home. Our model combines clinical support with modern technology, designed to work around your life.
Sword makes recovery easier and more accessible. You get high-quality care at home, guided by clinicians and supported by smart technology.
- Care that adapts to your progress in real time
- Licensed experts guiding every step
- Simple, non-invasive, evidence-based programs
- Proven results for pain relief, movement, and satisfaction
Did you know?
Many people worry that surgery is the only real answer. In reality, splinting has evidence of benefit and is often a reasonable first step for mild to moderate symptoms, especially when night waking is the main problem.⁴
How can I find pain relief for whiplash?
If your symptoms are mild or come and go, these low-risk strategies often help people feel more in control:
- Protect your sleep: Try a neutral wrist position at night. If you tend to curl your wrists, a night splint can help hold a more comfortable position.⁴
- Use pacing for hand-heavy tasks: Break long activities (typing, tools, hobbies) into shorter blocks with brief rests.¹²
- Reduce sustained gripping: Use larger grips when possible, and switch hands or change positions more often.¹²
- Pay attention to “warning signs”: If numbness becomes constant, thumb strength is clearly dropping, or symptoms rapidly worsen after an injury, get medical review promptly.¹²
If a new activity makes you sore but the pain settles within a day and doesn’t keep worsening, that’s usually a safe level of challenge.
