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Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist, causing numbness, tingling, and hand weakness; early treatment with splinting often prevents permanent nerve damage.

MusculoskeletalNeurologic
Carpal tunnel syndrome is the most common nerve-compression disorder of the arm. It develops when the median nerve — which supplies feeling to the thumb, index, middle, and part of the ring finger — is squeezed as it passes through the carpal tunnel, a narrow passageway of bone and ligament at the wrist. Millions of Americans are affected, women more often than men, and early treatment usually prevents lasting nerve damage. Symptoms often begin in the dominant hand, but both hands are affected in many people. Causes and Risk Factors: Anything that crowds, swells, or irritates the tissues inside the carpal tunnel can compress the nerve:
  • Repetitive hand and wrist use: Prolonged or forceful gripping, typing, and vibrating-tool work can aggravate the tendons that share the tunnel.
  • Wrist anatomy: Smaller carpal tunnels — more common in women — and prior wrist fractures leave less room for the nerve.
  • Medical conditions: Diabetes, hypothyroidism, and inflammatory arthritis that involves the wrist all increase risk.
  • Fluid retention: Pregnancy and other causes of swelling can temporarily compress the nerve; symptoms often resolve after delivery.
Symptoms: Symptoms usually start gradually and are often worse at night. Many people first notice them while holding a phone, gripping a steering wheel, or reading in bed:
  • Numbness and tingling: "Pins and needles" or burning in the thumb, index, and middle fingers — characteristically sparing the little finger.
  • Night waking: Many people wake with a numb hand and shake or hang it to restore feeling.
  • Weak grip and clumsiness: Dropping objects, difficulty buttoning clothes, or trouble holding a phone or steering wheel.
  • Advanced signs: Constant numbness or visible wasting of the muscle at the base of the thumb indicates prolonged compression and needs prompt attention.
Diagnosis: Diagnosis begins with the history and an examination of hand strength and sensation, often including simple provocative tests that tap or flex the wrist to reproduce symptoms. When the picture is unclear or surgery is being considered, nerve conduction studies and electromyography measure how well signals travel through the median nerve and grade the severity. These brief office tests also help rule out look-alike problems, such as a pinched nerve in the neck, which can cause similar tingling in the hand and arm. Your physician may also check for underlying contributors such as thyroid disease or diabetes. Treatment: Treatment depends on severity, and mild-to-moderate cases often respond well without surgery:
  • Night splinting: A wrist brace worn during sleep keeps the wrist in a neutral position and is the first-line treatment for most people; improvement is often noticeable within a few weeks of consistent use.
  • Activity modification: Adjusting workstation ergonomics, taking micro-breaks, and reducing forceful or vibrating tasks lowers daily strain on the nerve.
  • Corticosteroid injection: An injection into the carpal tunnel can reduce swelling around the nerve and relieve symptoms, sometimes for months.
  • Treating underlying conditions: Better control of diabetes, thyroid disease, or arthritis helps the nerve recover.
  • Surgery: Carpal tunnel release — cutting the ligament that roofs the tunnel — is a brief, highly effective outpatient procedure for severe or persistent cases.
Untreated severe compression can cause permanent numbness and weakness, so do not ignore hands that are frequently numb. The primary-care team at Zimmer Medical Group can confirm the diagnosis, start treatment, and refer you for nerve testing or surgery when needed — schedule a visit if hand numbness keeps returning.

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