A Clear Guide to Carpal Tunnel Syndrome
Hands Going Numb, Pins and Needles, and Weak Grip: A Clear Guide to Carpal Tunnel Syndrome
If you have ever felt your hands “fall asleep,” noticed pins and needles in your fingers, or struggled with grip strength, you are not alone. These symptoms can happen in one hand or both, and they can have many causes. But one of the most common causes is Carpal Tunnel Syndrome (CTS).
Carpal tunnel syndrome is a very common nerve condition. It can interfere with everyday tasks, reduce hand function, disturb sleep, and gradually affect overall health and quality of life. The good news is that if you understand it early and act in time, you can often prevent long-term pain and disability.
This article explains carpal tunnel syndrome in simple language: what it is, why it happens, what symptoms to look for, how doctors diagnose it, how to prevent it, and what treatments work.
What is Carpal Tunnel Syndrome?
Let’s break down the term:
Carpal refers to the wrist area.
Tunnel means a narrow passage.
Syndrome means a collection of symptoms caused by a particular problem.
Inside your wrist, there is a narrow tunnel-like space called the carpal tunnel. This tunnel is formed by:
Carpal bones at the base and sides (forming the “floor and walls”)
A strong band of tissue on top called the transverse carpal ligament (forming the “roof”)
Through this tight space pass:
Several tendons (structures that connect muscles to bones and move your fingers)
One important nerve called the median nerve
In carpal tunnel syndrome, pressure increases on the median nerve as it passes through the tunnel, leading to pain, numbness, tingling, and weakness in the hand.
Why Does the Median Nerve Get Compressed?
The carpal tunnel is a closed, limited space. If anything reduces the available space inside the tunnel, the median nerve gets squeezed.
This can happen in two main ways:
The tunnel becomes tighter (for example due to wrist shape changes, arthritis, or injury)
The contents inside swell (especially swelling of the tendons and surrounding tissues)
A simple way to imagine it: think of a narrow road tunnel. If a large vehicle tries to pass through a tight tunnel, pressure builds and damage can occur. Similarly, when the carpal tunnel becomes crowded or narrowed, the median nerve is compressed.
Once the nerve is compressed, inflammation and irritation develop, and symptoms appear in the areas supplied by that nerve.
Which Nerves Connect the Hand to the Brain?
The hand receives nerve supply mainly from three nerves:
Median nerve
Ulnar nerve
Radial nerve
Carpal tunnel syndrome specifically involves the median nerve, because it passes through the carpal tunnel.
Which Fingers Are Affected?
The median nerve supplies sensation to a large portion of the hand, especially:
Thumb
Index finger
Middle finger
Half of the ring finger (the thumb-side half)
So in typical carpal tunnel syndrome, symptoms are most noticeable in these areas. The little finger is usually not affected because it is mainly supplied by the ulnar nerve.
Who Gets Carpal Tunnel Syndrome Most Often?
Carpal tunnel syndrome can happen to anyone, but it is more common in:
Women
People aged roughly 30 to 60
People who do repetitive hand and wrist activities, whether due to work or household tasks
It is often linked with repeated wrist movements and prolonged hand use such as typing, mouse use, driving, sewing, embroidery, using tools, or working with vibrating machinery.
Symptoms of Carpal Tunnel Syndrome
Symptoms usually start gradually. In the beginning they may be mild and intermittent, but over time they can worsen.
Early Symptoms
Numbness in the thumb, index, middle, and half of the ring finger
Pins and needles (tingling)
A sensation that the hand has “gone to sleep”
Sometimes mild pain
Often, symptoms are worse at night, especially if the wrist is bent during sleep.
Moderate Symptoms
Reduced grip strength
Difficulty holding objects firmly
Trouble with fine tasks such as:
Opening bottle caps
Buttoning a shirt
Holding small items
Objects may start slipping from the hand
Pain may feel like burning, not just aching
Pain may spread beyond the hand into the forearm and sometimes up to the shoulder
Severe Symptoms
When compression continues for too long, the muscles supplied by the median nerve weaken.
A key sign is wasting of the thenar eminence, the fleshy raised area at the base of the thumb. In severe cases:
The thumb-side muscle mass starts to flatten
A visible hollow or dip may develop
Thumb movement becomes notably weak
Numbness can become constant
Permanent weakness or disability can occur if untreated
Why Symptoms Often Get Worse at Night
Many people notice symptoms at night because the wrist may remain bent for long periods during sleep. This increases pressure inside the carpal tunnel.
Symptoms can also occur or worsen when the wrist is flexed for long periods, for example:
Holding a phone for a long time while lying down or sitting
Holding a tablet or book for extended periods
Long periods of typing or mouse use
Driving for long durations
Common Causes and Risk Factors
Carpal tunnel syndrome can be linked to repetitive use, vibration exposure, medical conditions, structural issues, and hormonal changes.
Repetitive and Occupational Factors
Heavy computer use (typing and mouse)
Prolonged gripping
Driving frequently or for long hours
Use of vibrating machinery or tools
Factory work involving repetitive hand motions
Sewing, embroidery, carpentry, and similar tasks
Medical Conditions
Diabetes
Hypothyroidism
Rheumatoid arthritis
Gout
Obesity (strongly associated)
Structural and Hormonal Factors
Wrist fracture or wrist deformity
Arthritis changing wrist shape
Pregnancy (due to fluid retention and swelling)
Natural narrow carpal tunnel in some people (a congenital tendency)
In pregnancy, many cases improve after delivery as fluid retention reduces.
How is Carpal Tunnel Syndrome Diagnosed?
In most cases, diagnosis is made through:
History (your symptoms and when they occur)
Physical examination of the wrist and hand
Simple bedside tests during examination
Doctors may apply pressure or provoke symptoms in specific ways, such as:
Tapping over the carpal tunnel area to trigger tingling
Holding pressure over the median nerve area for a short time
Positioning the wrist in extreme flexion or extension to reproduce symptoms
Often, this combination is enough to diagnose CTS.
When Are Tests Needed?
In some situations, further tests may be used, such as:
Ultrasound
MRI
EMG (electromyography)
However, these are not needed in most routine cases.
Gold Standard Test
If confirmation is needed, the most reliable test is:
Nerve conduction studies
This measures how well electrical signals travel through the median nerve before and after the carpal tunnel. If the signal slows across the tunnel, it supports the diagnosis.
Prevention: How to Reduce the Risk
Prevention focuses on reducing repeated strain and keeping the wrist in a neutral, comfortable position.
Ergonomics: The Most Important Prevention Strategy
Ergonomics means arranging your work and posture so your body remains in its most comfortable and neutral position. When posture is neutral, muscles and nerves work with less strain.
Key points:
Keep the wrist straight during typing
Avoid bending the wrist up or down for long periods
Adjust the keyboard position so it aligns with elbow level
Keep your posture upright, and place the monitor at eye level
Keyboard Position
If the desk or keyboard is too low, the wrist bends upward. If too high, the wrist bends downward. Both positions can worsen pressure in the carpal tunnel.
Ergonomic Keyboards
Some ergonomic keyboards are split or angled to reduce wrist twisting and awkward angles, helping keep wrists neutral.
Mouse Use and Neutral Hand Position
Many standard mice keep the palm facing downward for long periods, which is not the hand’s most neutral position.
A more neutral position is when the palm faces inward. Some ergonomic or vertical mice help maintain that neutral hand posture.
Everyday Habits That Matter
Avoid sleeping with the wrist bent
Avoid placing your hand under the pillow or cheek in a way that bends the wrist
Do not wear very tight wristbands or watch straps
Take regular breaks from repetitive work
Add gentle stretching and strengthening exercises
Control weight if obesity is present
Manage diabetes and thyroid problems well
Treatment Options
Treatment depends on severity. Mild and moderate cases often improve with conservative care. Severe cases may need surgery.
1) Home and Conservative Treatment
Best for early to moderate symptoms.
Wrist splinting
This is often the first and most effective step. A wrist splint keeps the wrist straight, especially during sleep, preventing the wrist from bending and reducing pressure on the median nerve.
Cold therapy
If swelling or inflammation is present, cold packs around the wrist may reduce swelling and discomfort.
Activity modification
Reduce repetitive wrist actions when possible. If you cannot avoid the activity, take frequent breaks and reduce duration.
Exercises
Two important exercise types are often recommended:
Tendon gliding exercises
Median nerve gliding exercises
These aim to improve smooth movement of tendons and the nerve through the tunnel, like gently loosening a cable that runs through a tight pipe. Ideally, they should be learned under a physiotherapist’s guidance, but many people can do them at home once properly taught.
A practical routine is to do multiple sequences in the morning and again in the evening, consistently.
2) Medical Treatment
Used when symptoms are more intense or not improving.
NSAIDs (anti-inflammatory painkillers)
These can reduce pain temporarily but are not a permanent cure for nerve compression.
Corticosteroid injection
A steroid injection into the wrist can reduce inflammation and swelling, often giving fast relief that may last for months. In some cases, it can provide long-lasting improvement, but repeated injections are not advised if symptoms keep returning.
Physiotherapy
Physiotherapy can help with:
Stretching and gliding exercises
Strengthening
Ergonomic training and posture correction
Treat underlying causes
If diabetes, hypothyroidism, or other conditions are contributing, controlling them is important.
In pregnancy-related CTS, symptoms often improve after pregnancy without major intervention.
3) Surgical Treatment: Carpal Tunnel Release
Surgery is considered when:
Symptoms are severe
Thenar muscle wasting has begun
Thumb weakness is significant
Symptoms persist despite 6 to 12 weeks of good conservative treatment
Nerve conduction studies show significant compression
What surgery does
The transverse carpal ligament (the roof of the tunnel) is cut to release pressure on the median nerve.
Two common surgical methods
Open surgery: a moderate incision, ligament is cut under direct vision
Endoscopic surgery: a small incision, camera inserted, ligament cut with an endoscopic tool
Results
Carpal tunnel release generally has excellent outcomes, with success rates often quoted around the mid-90% range. Many patients notice relief quickly, though full recovery may take 2 to 3 months. If grip weakness existed before surgery, regaining strength may take longer.
Possible complications
Like any surgery, risks exist, including:
Infection
Incomplete release (persistent symptoms)
Very rarely, nerve injury (especially uncommon with experienced surgeons)
For patients who truly need surgery, the benefits usually outweigh these risks.
Final Takeaway
Carpal tunnel syndrome is one of the most common reasons for hand numbness and tingling. It happens when pressure builds on the median nerve inside the wrist’s carpal tunnel. It is more common in women and typically appears between ages 30 and 60. Symptoms often start mildly, worsen gradually, and are frequently worse at night.
The most important message is this: early understanding and timely action can prevent long-term pain and disability.