Carpal tunnel syndrome is one of the most common causes of tingling and numbness in the hand. It happens when the median nerve is squeezed as it passes through a narrow tunnel at the front of the wrist. It often starts with pins and needles at night and, if left untreated, can lead to a weak grip.
This guide explains what carpal tunnel syndrome is, the symptoms and early signs, how it is tested and the treatments that work.
Quick answer
Carpal tunnel syndrome is pressure on the median nerve at the wrist. Typical symptoms are pins and needles, numbness or pain in the thumb, index finger, middle finger and half of the ring finger, often worse at night and eased by shaking the hand. Later, the thumb can feel weak and you may drop things. It is usually diagnosed from your symptoms and simple tests in clinic, sometimes with nerve conduction studies. Treatment starts with a night splint and activity changes, with steroid injections or a minor operation for persistent or severe cases.
What is carpal tunnel syndrome?
The carpal tunnel is a narrow passage in the wrist formed by small bones and a tough band of tissue. The median nerve and the tendons that bend the fingers pass through it. When the space becomes tighter, for example from swelling, fluid retention or repeated bending of the wrist, the nerve is compressed and stops working properly. It is around three times more common in women and most common between 40 and 60.
Symptoms of carpal tunnel syndrome
- Pins and needles or numbness in the thumb, index, middle and half of the ring finger
- Symptoms that wake you at night or are there first thing in the morning
- Relief from shaking or flicking the hand
- Pain or aching in the hand, wrist or forearm
- Symptoms when holding a phone, driving or reading
- A weak grip, clumsiness or dropping things
- In longer-standing cases, flattening of the muscles at the base of the thumb
The little finger is usually not affected. Numbness in the little finger points to a different nerve, often trapped at the elbow.
Early signs of carpal tunnel
The first sign is often tingling in the fingers on waking, or needing to shake your hand during the night. At this stage, symptoms come and go. Constant numbness or weakness suggests more pressure on the nerve and should be assessed promptly.
How do you know if you have carpal tunnel?
A clinician will ask about your symptoms and examine your hand and wrist, checking sensation and thumb strength. Simple clinic tests include tapping over the nerve at the wrist, known as Tinel's test, and holding the wrists bent for about a minute, known as Phalen's test, to see whether tingling appears. The neck is also checked, because a trapped nerve in the neck can cause similar symptoms. Nerve conduction studies, which measure how well the nerve carries signals, are used if the diagnosis is unclear, symptoms are severe or surgery is being considered.
What causes carpal tunnel?
Common risk factors include repetitive gripping or wrist bending, pregnancy, the menopause, diabetes, an underactive thyroid, rheumatoid arthritis, a previous wrist fracture and carrying extra weight. Often there is no single cause. See underactive thyroid symptoms if you also feel tired and cold.
Carpal tunnel treatment
- Wrist splint at night. Keeps the wrist straight to reduce pressure on the nerve. Usually the first treatment, worn for at least four weeks.
- Activity changes. Breaks from repetitive gripping and keeping the wrist in a neutral position at the keyboard.
- Exercises. Nerve and tendon gliding exercises can help some people. See carpal tunnel exercises.
- Steroid injection. Can reduce symptoms for weeks to months, particularly in mild to moderate cases.
- Carpal tunnel release surgery. A short procedure, usually under local anaesthetic, that cuts the band of tissue to make more room for the nerve. It is recommended for severe or persistent symptoms, or when there is weakness or muscle wasting.
Carpal tunnel during pregnancy often settles within a few months of giving birth.
When to seek medical help
Call 999 if you have:
- Sudden numbness or weakness in one arm or hand with drooping of the face or slurred speech, which can be signs of a stroke
Get same-day medical advice, from your GP or NHS 111, if:
- You have sudden severe numbness or weakness in the hand after a wrist injury
- Your wrist looks deformed or is very swollen after a fall
See your GP if:
- Numbness is constant rather than coming and going
- Your thumb feels weak or the muscles at its base look flatter
- Symptoms have not improved after a few weeks of splinting
- Symptoms are affecting your sleep or work
Frequently asked questions
Does carpal tunnel go away on its own?
Mild carpal tunnel, especially in pregnancy, can settle without treatment. Constant numbness or weakness is less likely to resolve and needs assessment.
Is carpal tunnel serious?
It is not dangerous, but long-standing pressure can cause lasting numbness and weakness, so it is worth treating early.
Can carpal tunnel affect both hands?
Yes. It often affects both hands, although one is usually worse, most often the dominant hand.
How long does recovery from carpal tunnel surgery take?
Most people use the hand for light tasks within a few days, return to desk work within a few weeks and recover grip strength over a few months.
Carpal tunnel assessment in Chiswick
Carpal tunnel syndrome is assessed at Omnia Lifestyle in Chiswick, W4, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking. Our physiotherapists check sensation, grip strength and the neck, give splint advice and nerve gliding exercises, and can add manual therapy, acupuncture or laser therapy for mild to moderate symptoms. If we find signs of significant nerve compression, we write to your GP so you can be referred without delay.
Read more about carpal tunnel syndrome, see carpal tunnel exercises and peripheral neuropathy, explore physiotherapy, manual therapy and acupuncture, or book an assessment.
This article is general information, not medical advice. If you have any of the warning signs listed above, seek medical attention.
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