On this page
Carpal tunnel syndrome
Tingling, numbness or a weakening grip in your hand? Carpal tunnel syndrome is a common and very treatable cause. This page explains what it is, why it happens, how it’s diagnosed and the options for managing it.
What is it?
Carpal tunnel syndrome happens when the median nerve, which runs from the forearm into the hand, is squeezed as it passes through a narrow passage in the wrist called the carpal tunnel. This pressure on the nerve causes numbness, tingling and sometimes pain, usually in the thumb, index finger, middle finger and part of the ring finger. It is one of the most common nerve conditions affecting the hand and is very treatable.
At a glance
What is it?
Pressure on the median nerve as it passes through a narrow tunnel in the wrist
Common symptoms
Numbness, tingling and pain in the thumb, index and middle fingers, often worse at night
Who it affects
More common in women aged 40 to 60, and in manual workers but can affect anyone
Is it serious?
Not dangerous, but long-standing pressure on the nerve can cause lasting numbness and weakness
Treatment options
Splinting, activity changes, injection, or surgery
First step
A consultation to confirm the diagnosis and assess the severity of nerve compression
Causes and risk factors
- A naturally narrow carpal tunnel
- Repetitive or forceful hand and wrist movements
- Pregnancy, due to fluid retention
- Diabetes or an underactive thyroid
- Rheumatoid arthritis or other inflammatory conditions
- A family history of carpal tunnel syndrome
- A previous wrist fracture
In many people no single cause is found, and the tunnel is simply narrower than average. Other health conditions and some occupations that involve repetitive gripping or vibration can make symptoms more likely. The symptoms are due to inadequate blood flow to the median nerve as a result of pressure on the nerve.
Symptoms and how carpal tunnel syndrome presents
The most common symptoms are numbness, tingling or a pins-and-needles feeling in the thumb, index finger, middle finger and half of the ring finger. Symptoms are often worse at night and can wake you from sleep. Shaking or flicking the hand may bring temporary relief.
As pressure on the nerve increases, some people notice weaker grip, clumsiness or a tendency to drop things. In longer-standing cases the muscle at the base of the thumb can become noticeably smaller.
How is carpal tunnel syndrome diagnosed?
Carpal tunnel syndrome is usually diagnosed from your history and a hand examination. Dr Tomlinson will ask about your symptoms and test the sensation and strength in your hand.
A nerve conduction study (a test that measures how well signals travel along the median nerve) is often used to confirm the diagnosis and to show how severe the compression is. This helps guide which treatment is likely to help most.
Treatment options for carpal tunnel syndrome
Treatment depends on how severe your symptoms are and how they are affecting your daily life.
Mild to moderate symptoms are often helped by wearing a wrist splint, particularly at night, and by changing activities that make symptoms worse. A corticosteroid injection into the carpal tunnel can settle symptoms, sometimes for a good period of time.
If symptoms are marked, interfering with sleep, do not improve with these measures, or the nerve conduction study shows significant compression, carpal tunnel release surgery is usually recommended. This is a common, well-established day procedure that divides the ligament pressing on the nerve to relieve the compression.
When to see a hand surgeon
See a hand surgeon if you have ongoing numbness or tingling in your hand, especially if it wakes you at night, if you notice weaker grip or are dropping things, if simple measures like nocturnal splinting and activity modification have not helped and if you are looking for a lasting solution. Earlier assessment gives more treatment options and reduces the risk of lasting nerve damage.
What to expect at your appointment
Our intake form asks you specific questions about your carpal tunnel syndrome symptoms, to quantify the severity of your symptoms.
At your first appointment, Dr Tomlinson will take a history of your symptoms and examine your hand and wrist. She may refer you for nerve conduction studies if this is desirable and has not already been done. Together you will discuss the diagnosis and go through the treatment options that suit your situation, so you can make an informed decision about what to do next.
Watch: Understanding Carpal Tunnel Syndrome
Related conditions and treatments
Carpal tunnel syndrome is one of several nerve compression conditions affecting the arm and hand. If your numbness or tingling involves the ring and little fingers rather than the thumb and index finger, you may be experiencing cubital tunnel syndrome, which involves the ulnar nerve at the elbow instead, or ulnar nerve compression at the wrist (Guyon’s canal), which involves the ulnar nerve at the wrist. It is possible to have more than one nerve compression at the same time.