Carpal tunnel syndrome

The carpal tunnel is a narrow passage on the palm side of the wrist, bounded by the small wrist bones and a tight band of tissue. The median nerve and the tendons that bend the fingers pass through it. When pressure rises in this confined space, the nerve is compressed and the characteristic symptoms follow.

Often no single cause is found. Several factors raise the risk, including:

• Repetitive or forceful hand use, prolonged gripping or vibration
• Pregnancy, where fluid retention can cause symptoms that often settle afterwards
• Hormonal and metabolic conditions, such as an underactive thyroid or diabetes
• Inflammatory arthritis, including rheumatoid arthritis, which can swell the tunnel lining
• A previous wrist fracture, or simply the shape of the wrist

It is more common in women and tends to occur in mid-life.

Carpal tunnel syndrome has a fairly typical pattern. Features include:

• Tingling, numbness or pins and needles in the thumb, index and middle fingers
• Symptoms that are often worse at night and may wake you
• A tendency to shake or flick the hand to relieve the sensation
• In time, weakness of grip or clumsiness of the hand

The diagnosis can usually be made from the characteristic symptoms and an examination, sometimes supported by nerve studies. It is also worth checking whether any underlying factor is contributing.

Ultrasound can be used to look at the nerve at the wrist and assess the surrounding structures, supporting the diagnosis. It also allows any injection to be placed accurately. Dr Borukhson uses point-of-care ultrasound during the consultation. You can read more on the ultrasound clinic page.

Treatment depends on how troublesome and long-standing the symptoms are. Milder cases often respond to simple measures such as a wrist splint, particularly at night. Where symptoms persist, an ultrasound-guided injection around the carpal tunnel can relieve them, and ultrasound guidance helps place it precisely. More severe or persistent cases may need referral for consideration of a surgical option. The right approach is discussed with you.

Small adjustments to how you use the hand can ease day-to-day symptoms. It helps to take regular breaks from sustained gripping or typing, to keep the wrist in a neutral, unbent position, and to set up your desk, keyboard and tools so the wrist is not held flexed or extended for long periods.

If symptoms wake you at night, gently moving and shaking the hand often settles them. Where a contributing condition such as a thyroid problem or diabetes is present, keeping it well managed supports recovery.

The outlook is generally reassuring. Many people improve with simple measures, and symptoms linked to a temporary cause, such as pregnancy, frequently resolve once that passes. Keep a note of any change so it can be reviewed.

Most carpal tunnel symptoms can be assessed routinely, but some changes warrant a more prompt review. Arrange an earlier appointment if you notice:

• Constant numbness that no longer comes and goes, or numbness you can no longer relieve by moving the hand
• Weakness, clumsiness or dropping things, or difficulty with buttons, keys or fine pinch
• Wasting or flattening of the muscle at the base of the thumb
• Symptoms that are rapidly worsening or spreading

These suggest the nerve is under sustained pressure, and addressing them promptly gives the best chance of recovery before any change becomes lasting.

Seek same-day medical advice if numbness or weakness comes on suddenly or follows a significant wrist injury, as this needs separate, urgent assessment.

Addressed early, carpal tunnel syndrome often responds well to straightforward measures, and assessing it promptly helps protect the nerve before any weakness develops. If you have tingling or numbness in the hand, especially at night, a specialist review can confirm the cause and set out the options.

How is carpal tunnel syndrome diagnosed?

The diagnosis can usually be made from the characteristic symptoms, such as night-time tingling in the thumb, index and middle fingers, together with an examination, and nerve studies are sometimes used to confirm it. Dr Borukhson also uses point-of-care ultrasound during the consultation to look at the nerve at the wrist and the surrounding structures, which supports the diagnosis. It is also worth checking whether any underlying factor is contributing.

Will carpal tunnel syndrome go away on its own?

Milder symptoms can settle, especially with simple measures such as wearing a wrist splint at night, and some cases linked to a temporary cause may ease once that is addressed. Many people, though, find the symptoms persist or gradually worsen without treatment. Having it assessed early gives the best chance of a good response and helps protect the nerve before any weakness develops.

Do I need surgery for carpal tunnel syndrome?

Not always. Many people improve with a wrist splint or, where symptoms persist, an ultrasound-guided injection around the carpal tunnel, which ultrasound helps place precisely. Surgery is usually considered for more severe or long-standing cases, or where simpler measures have not helped, and the right approach is discussed with you.

Is carpal tunnel syndrome serious?

For most people it is uncomfortable rather than dangerous, and it often responds well to treatment, particularly when addressed before symptoms become persistent. If it is left for a long time, the pressure on the nerve can lead to lasting weakness or numbness in the hand, which is harder to reverse. This is why a specialist review is worthwhile if you have tingling or numbness in the hand, especially at night.