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Carpal tunnel syndrome


Expert reviewer, Ian Grant, Consultant in Plastic Surgery and Hand Surgery
Next review due April 2024

Carpal tunnel syndrome is caused by pressure on a nerve in your wrist. This most commonly causes tingling, numbness, pain and weakness in your hand. Carpal tunnel syndrome can sometimes get better on its own. But there are also treatments that can help.

Image showing the carpal tunnel and median nerve

What is carpal tunnel syndrome?

Carpal tunnel syndrome is when a nerve, called the median nerve, in your wrist becomes compressed (squeezed). This nerve controls the feeling in your thumb, index, middle and ring fingers. It also controls muscles in your thumb. When it’s compressed, it leads to the symptoms of numbness, tingling, pain and weakness.

Your median nerve runs through a narrow channel in your wrist called the carpal tunnel. The channel is formed from your wrist bones and a tough band of tissue known as the transverse carpal ligament, which is on the top. Anything that reduces the space or increases the pressure in your carpal tunnel can cause carpal tunnel syndrome.

Carpal tunnel syndrome affects people of all ages, but is more common over the age of 50. Women are more likely to develop it than men.

Causes of carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of a nerve in your wrist called the median nerve. There are lots of reasons why this may happen and it’s often difficult to identify one specific cause. It’s likely to be due to several factors. The following can make you more likely to develop it:

  • being overweight
  • having certain other health conditions including diabetes or an underactive thyroid
  • pregnancy – this may be due to the associated hormonal changes and fluid retention
  • injury to your wrist such as a wrist fracture
  • doing repeated activities that put your wrist in an unnatural position – either very flexed or extended (bent either forwards or backwards)
  • some inflammatory conditions such as rheumatoid arthritis
  • a tumour or growth which might press on your nerve or make your carpal tunnel narrower
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Symptoms of carpal tunnel syndrome

Carpal tunnel symptoms tend to affect your thumb and fingers (apart from your little finger). Symptoms include:

  • numbness
  • a tingling feeling or pins and needles
  • weakness and finding it difficult to grip
  • pain or a burning feeling

You can have carpal tunnel symptoms in both hands or just one. It can start to affect your whole hand and may also spread up your arm. Your symptoms may be mild at first, but they may gradually get worse. You can get carpal tunnel symptoms at any time but they’re often worse at night and may wake you up. Certain activities may also trigger your symptoms in the day.

Your carpal tunnel syndrome symptoms may feel better if you shake your wrist or change its position.

If you have any of these symptoms, contact your GP for advice.

Diagnosis of carpal tunnel syndrome

Your GP will ask you about your symptoms and your medical history. They’ll want to know when you get symptoms, what triggers them, and how they’re affecting your daily life. They’ll carefully examine both your hands, looking for signs such as swelling or muscle wasting. They’ll also check the feelings in your fingers and thumb. They may carry out some brief tests to check your symptoms. These may include:

  • asking you to bend your wrist with your palm towards your forearm
  • tapping or pressing over your median nerve on the inside of your wrist
  • pressing on the ligament over your carpal tunnel in your wrist

Your GP may be able to diagnose carpal tunnel syndrome just by examining you and asking about your symptoms. But sometimes they may ask you to have some further tests. These may include the following.

  • Nerve conduction test – this can show how bad any damage to your median nerve is.
  • Ultrasound – this allows your doctor to look inside your wrist, and can help to show if there’s any underlying cause.

Self-help for carpal tunnel syndrome

There may be things you can do to manage your symptoms. If there are particular activities that seem to trigger your symptoms, try to avoid these if you can. It may help if you change the way you do these actions or reduce how often you do them. If you’re overweight, losing any excess weight may help to reduce your symptoms.

If you find your symptoms are worse at work, talk to your manager or occupational health department if you have one. They may be able to help with modifications to your workplace or a temporary change to your duties. For example, they may be able to give you a different style of keyboard or provide you with some wrist rests that can help.

Treatment of carpal tunnel syndrome

You don’t always need treatment for carpal tunnel syndrome. For some people, the symptoms improve on their own within about six months. This is more likely if you’re under 30, and especially if your symptoms are due to pregnancy.

Treating any underlying condition such as arthritis may improve your carpal tunnel symptoms.

Wrist splints for carpal tunnel syndrome

Wrist splints can help to keep your wrist straight and reduce pressure on your compressed nerve. This can help with night-time symptoms in particular. Your doctor will usually advise you to wear wrist splints at night for at least six weeks. You can also wear splints during the day, but you may find that they get in the way as you go about your daily routines.

You can buy a wrist splint online or from a pharmacy.

Steroid injections for carpal tunnel syndrome

Your GP may offer you a steroid injection into your carpal tunnel to help relieve your pain. You may be able to have this at your GP surgery or they may need to refer you to a specialist for the treatment.

Steroid injections work well for many people but it can take a few weeks to get the full effects. They don’t work for everyone. They can also wear off after a while and your symptoms may come back. If your symptoms do return, you may be able to have a repeat injection but it’s not always effective.

Carpal tunnel surgery

If your symptoms are severe or other treatments haven’t worked, your GP may refer you to a hand specialist or local musculoskeletal service. They will assess you to see if carpal tunnel surgery (also called carpal tunnel release surgery) would be an option.

Carpal tunnel surgery is usually carried out as a day case, under local anaesthesia. This means you’ll have the procedure and go home on the same day. The area will be numb so you don’t feel any pain. The procedure involves dividing the ligament in your wrist that forms part of your carpal tunnel. This will relieve pressure on your median nerve. It’s generally very effective and has a high success rate. Up to nine in 10 people find that their symptoms improve. As with all surgery, there are some risks involved. There’s also a chance that your symptoms may come back after surgery. It’s important to talk this over with your doctor before you decide whether or not surgery is the right choice for you.

Other carpal tunnel syndrome treatments

Exercise therapy

Some people find that hand and wrist exercises can help with carpal tunnel syndrome symptoms. If you see a physiotherapist, they may recommend some of these exercises. Some are simple exercises to improve the strength and flexibility in your wrist. Others, known as nerve glide exercises, specifically aim to help your trapped nerve move more freely. There isn’t much good evidence to show that these exercises help though. You shouldn’t do any activity that makes your symptoms worse.

Complementary therapies

Some people find acupuncture helps to relieve the symptoms of carpal tunnel syndrome. But there’s not enough evidence to say for sure that it works.

Some people also find that yoga helps to relieve pain associated with carpal tunnel syndrome. But again, more research is needed to know for sure.

If you decide to try a complementary therapy, check that your therapist is registered with a recognised organisation.

Frequently asked questions

  • You’re likely to notice a tingling feeling, pins and needles, pain or numbness in your fingers and thumb if you have carpal tunnel syndrome. But it can affect your whole hand and can also spread up your arm – sometimes as far as your shoulder. You may feel it just during the night or throughout the day too. It might be that certain activities – such as writing, typing or heavy chores – bring your symptoms on.

  • Yes. Although carpal tunnel can get better by itself or may go away with treatment, it’s possible for symptoms to come back again. Steroid injections may only work for a limited time. And symptoms may also come back after surgery. Talk to your doctor if your symptoms have come back again. They may suggest further investigations and other treatments.

  • If you have carpal tunnel syndrome, your symptoms may sometimes go away on their own within about six months. If your symptoms are due to pregnancy, they’re likely to go away soon after you’ve given birth. If you try wearing a splint, your doctor will usually advise you to do this for at least six weeks. If your symptoms don’t improve after this, your doctor may advise other treatments.

  • At night, you’re more likely to bend your wrist without realising. This increases the pressure on your nerve as it passes through your carpal tunnel, leading to more symptoms. This is why wearing a splint at night is one of the first things that’s usually advised. A splint will keep your wrist in a neutral position, so you can’t bend it.

  • Both osteoarthritis and carpal tunnel syndrome can cause symptoms in your hand and wrist. It’s common to have both carpal tunnel syndrome and osteoarthritis. But with osteoarthritis, you’re more likely to have painful, swollen or stiff joints around your wrist. Pain and swelling will just be in the affected joint. You may notice grating, cracking or popping sensations around your wrist when you move it. You may also find it difficult to grip things or to lift heavy objects.

    Carpal tunnel syndrome is more likely to cause a tingling sensation around your hand. You won’t usually be able to see any physical signs. And the discomfort won’t be in such a specific area as when you have osteoarthritis. For more information about carpal tunnel symptoms, see our section on symptoms above.



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Related information

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    • Carpal tunnel syndrome. BMJ Best Practice. bestpractice.bmj.com, last reviewed 3 February 2021
    • Carpal tunnel syndrome. Versus Arthritis. versusarthritis.org, last accessed 3 March 2021
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    • Carpal tunnel syndrome. Medscape. emedicine.medscape.com, updated 30 March 2020
    • Personal communication. Ian Grant, Consultant in Plastic Surgery and Hand Surgery, 7 April 2021
    • Commissioning guide: treatment of carpal tunnel syndrome. British Orthopaedic Association. www.boa.ac.uk, published November 2017
    • Page MJ, O'Connor D, Pitt V, et al. Exercise and mobilisation interventions for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, (6). doi: 10.1002/14651858.CD009899
    • Choi GH, Wieland LS, Lee H, et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2018, (12). doi: 10.1002/14651858.CD011215.pub2
    • Carpal tunnel syndrome. OrthoInfo. American Academy of Orthopaedic Surgeons. orthoinfo.aaos.org, last reviewed July 2016
    • Page MJ, Massy‐Westropp N, O'Connor D, et al. Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews 2012, (7). doi: 10.1002/14651858.CD010003
    • Osteoarthritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2018
    • Musculoskeletal problems. Oxford Handbook of General Practice. Oxford Medicine Online. oxfordmedicine.com, published online June 2020
    • Overview of occupational overuse syndromes. BMJ Best Practice. bestpractice.bmj.com, last reviewed 4 February 2021
  • Reviewed by Pippa Coulter, Freelance Health Editor, April 2021
    Expert reviewer, Ian Grant, Consultant in Plastic Surgery and Hand Surgery
    Next review due April 2024

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