Carpal tunnel syndrome (CTS) happens when the median nerve is compressed as it passes through a narrow space at the wrist called the carpal tunnel. The median nerve carries sensation from much of the thumb, index and middle fingers and the thumb-side of the ring finger, and it also supplies some of the muscles that move the thumb.
What symptoms can carpal tunnel syndrome cause?
- Tingling or pins and needles in the hand and fingers.
- Numbness, particularly in the thumb, index and middle fingers.
- Pain or aching in the hand, which can sometimes travel into the forearm.
- Symptoms that are often worse at night or first thing in the morning.
- Weakness, difficulty with fine tasks or dropping things if the nerve is more severely affected.
Some people feel symptoms across most of the hand, so the pattern is not always completely typical. Other problems, including pressure on nerves elsewhere in the arm or neck, can sometimes produce similar symptoms.
Why does it happen?
Often there is no single identifiable cause. Anything that reduces the available space within the carpal tunnel or makes the tissues within it swell can increase pressure on the median nerve. CTS is associated with a number of factors including diabetes, thyroid disease, pregnancy, inflammatory or degenerative problems around the wrist, previous wrist injury and some types of repetitive or vibration-related work.
How is CTS diagnosed?
The diagnosis is usually based on your symptoms and an examination of the hand, wrist and arm. The clinician may assess sensation, thumb strength and grip and may use tests that reproduce pressure on the median nerve. Nerve conduction studies can be useful when the diagnosis is uncertain, when symptoms are severe or atypical, or when the result is likely to influence treatment.
Does everybody need surgery?
No. Treatment depends on the severity and duration of your symptoms, examination findings, whether there is weakness or muscle loss, and what matters to you.
Non-surgical treatment
- Wrist splint: a splint that keeps the wrist in a neutral position, particularly at night, can reduce symptoms for some people.
- Activity changes: reducing or adapting activities that repeatedly provoke symptoms may help.
- Steroid injection: an injection into the carpal tunnel can reduce symptoms, although the benefit may wear off with time.
- Treating contributing conditions: where relevant, addressing problems such as thyroid disease or inflammatory arthritis may help.
Carpal tunnel decompression surgery
Surgery may be recommended when symptoms are persistent or severe, when there is weakness or evidence of significant nerve compression, or when other treatment has not provided enough relief. Carpal tunnel decompression releases the ligament forming the roof of the tunnel to create more space for the median nerve.
Help with deciding what is right for you
There is not one treatment that is right for everybody. The NHS England decision support tool sets out the main options and is designed to help you consider the possible benefits and disadvantages alongside what matters most to you.
Exercises and self-management
The Chartered Society of Physiotherapy provides a simple illustrated exercise programme for carpal tunnel syndrome. Exercises are not a substitute for assessment where symptoms are severe or there is weakness or muscle loss.
If you are being considered for surgery
If you have been referred to Midlands Community Services, your clinician will consider your symptoms, examination findings and any relevant investigations with you. Please also read our preparation information before your procedure.
For further general information you can also read the NHS carpal tunnel syndrome information.