Carpal tunnel syndrome is a condition in which the median nerve is squeezed as it passes through a narrow channel in the wrist, causing numbness, pain and weakness in the hand. In many cases it is treated with non-surgical options, and surgery may be considered when needed.
Note: This is general information. Hand numbness has several possible causes, and diagnosis needs an in-person examination and sometimes nerve testing.
Symptoms
Symptoms that may be linked to this condition include:
- Numbness or tingling in the thumb, index and middle fingers
- Pain in the hand or wrist that may spread up the forearm
- Symptoms that often worsen at night and wake you from sleep
- Weak grip and dropping things
- A feeling of swelling in the hand
- Difficulty with fine tasks such as writing or buttons
Causes
There is no single cause, and contributing factors may include:
- Repetitive hand and wrist movements or vibrating tools
- Holding the wrist bent for long periods
- Pregnancy and hormonal changes
- Certain long-term conditions such as diabetes and thyroid disorders
- Previous wrist injuries
- Family tendency and the shape of the wrist
Diagnosis
The doctor asks about your symptoms and when they get worse, then examines the hand and wrist, feeling and strength, and performs clinical tests. A nerve conduction study may be requested to confirm nerve compression and judge how severe it is.
Symptoms can look like other problems such as nerve compression in the neck or elbow, so an in-person examination is needed. See also the hand numbness guide.
Treatment options
Non-surgical treatment
In mild or moderate cases the following options may be enough:
- A wrist splint at night that holds the wrist in a neutral position
- Activity changes and avoiding movements that trigger symptoms
- Stretching and nerve-gliding exercises guided by a specialist
- Physiotherapy
- Local injections or other treatments under medical supervision in some cases
- Managing any related condition such as diabetes
Surgical treatment
Surgery may be considered when symptoms continue, when weakness or wasting of the hand muscles appears, or when the nerve is severely compressed. The ligament that narrows the tunnel is released to take pressure off the nerve. It is done through a small incision, and in some cases arthroscopically.
Many patients may have less numbness and pain, but results vary, and the surgeon explains the risks beforehand. For other nerve operations, read Peripheral Nerve Surgery.
Recovery and rehabilitation
Recovery time varies from person to person and is set by the surgeon after assessment. Numbness and strength can be slow to improve, especially if the compression was severe.
- Wound care as your surgeon instructs
- Moving the fingers early to limit stiffness
- Avoiding heavy loads until the surgeon allows
- Exercises to regain strength and movement
- A gradual return to work and activities
When to see the doctor
See an orthopedic surgeon if you have:
- Repeated hand numbness or numbness that wakes you at night
- Weak grip or dropping things
- Symptoms that continue despite rest and a splint
- Wasting of the muscles at the base of the thumb
- Loss of feeling in the fingers