Utku Gürhan

Hand and wrist

Carpal Tunnel Syndrome: Hand Numbness, Treatment and Surgery

Written by: Asst. Prof. Dr. Utku GürhanLast updated:

In short

Carpal tunnel syndrome is a common condition in which the median nerve is squeezed in a narrow channel at the wrist, causing numbness, tingling and night-time pain in the thumb, index and middle fingers. Mild to moderate cases are usually treated first with a night splint, activity changes and, if needed, a steroid injection. Surgery is considered when symptoms persist despite these treatments, are severe, or when there is muscle wasting or clear nerve damage; it is usually a day-case procedure.

What is carpal tunnel syndrome?

On the palm side of the wrist there is a narrow passage formed by the wrist bones and a thick ligament across them. The median nerve runs through this passage together with the tendons that bend the fingers. When pressure inside the tunnel rises, the nerve is compressed; this is carpal tunnel syndrome [1]⁠[3].

The median nerve supplies feeling to the thumb, index finger, middle finger and part of the ring finger, which is why symptoms are usually felt in these fingers [1]⁠[3].

What are the symptoms?

Symptoms usually start gradually and may get worse over time. The most common are [1]⁠[2]⁠[3]:

  • Numbness, tingling or burning in the thumb, index and middle fingers
  • Symptoms that are worse at night and wake you up, often eased by shaking the hand
  • Pain in the fingers or hand that may spread up the arm
  • Weaker grip, clumsiness and dropping objects
  • In advanced cases, thinning of the muscles at the base of the thumb

What causes it, and who is at risk?

In most people no single cause is found, and several factors act together. Being born with a narrower tunnel, repetitive work that involves forceful wrist bending, and holding the wrist in extreme positions for long periods may all raise the risk [1]⁠[2].

Pregnancy, excess body weight, diabetes, inflammatory joint disease such as rheumatoid arthritis, a family history of the condition and a previous wrist injury are also recognised risk factors [1]⁠[2].

How is it diagnosed?

Diagnosis rests mainly on the history and examination. The doctor checks feeling and muscle strength in the hand and may tap over the wrist or hold it in certain positions to see whether the symptoms are reproduced [1]⁠[3].

Nerve conduction studies and electromyography (EMG) show how badly the nerve is affected and help rule out other nerve problems. Ultrasound, X-rays or MRI are used in selected cases. These tests are not needed for everyone [1]⁠[3].

Non-surgical treatment

Mild to moderate symptoms are usually treated without surgery first. A night splint that keeps the wrist straight, reducing activities that strain the wrist, and short-term painkillers are the first steps [1]⁠[2].

A Cochrane review found that the evidence on splinting is limited, but a night splint may give some patients an overall improvement in the short term and is unlikely to cause serious harm [5].

If a splint does not help enough, a steroid injection into the carpal tunnel may be offered. Injections often reduce symptoms, although in some patients the effect is temporary [1]⁠[2].

When is carpal tunnel surgery considered?

Surgery is considered when symptoms continue or return despite non-surgical treatment, when symptoms are severe and long-lasting, when tests show significant nerve damage, or when the muscles at the base of the thumb start to waste [1]⁠[3]. Muscle wasting and constant numbness suggest a risk of permanent nerve damage and should not be left untreated [1].

The decision is shared and depends on how severe the symptoms are and on the patient's preference. A Cochrane review notes that people with tolerable symptoms can start with non-surgical options, while those with severe symptoms may choose surgery [4]. In a large randomised trial, patients who started with surgery were more likely to have recovered at 18 months than those who started with a steroid injection [6].

The operation, called carpal tunnel release, divides the ligament that presses on the nerve so that the tunnel becomes wider. It is usually done under local anaesthetic, takes a short time, and you go home the same day [1]⁠[2]⁠[3].

Recovery

Night-time waking often eases within the first week after surgery. The hand can usually be used gently for light tasks within a few days [1]⁠[3].

A full return to everyday activities often takes a few weeks. Grip strength can take several months to recover. When compression has been severe and long-standing, feeling may take up to a year to improve and may not return completely. Tingling usually improves sooner than strength [1]⁠[2]⁠[3].

When should you see a doctor promptly?

Do not delay an assessment if you notice any of the following [1]⁠[2]:

  • Numbness that becomes constant, or increasing loss of feeling
  • Thinning of the muscles at the base of the thumb or clear loss of strength
  • Frequently dropping things or difficulty with buttons
  • Symptoms that get worse or do not settle despite home measures

Frequently asked questions

+What causes numbness in the hand?

Hand numbness has many causes. When numbness affects the thumb, index and middle fingers and is worse at night, the most common cause is carpal tunnel syndrome. Other nerve problems can cause similar symptoms, so an examination and, if needed, a nerve conduction test are important [1]⁠[2].

+Does carpal tunnel syndrome go away on its own?

Mild symptoms may improve by reducing activities that strain the wrist and wearing a night splint. If symptoms persist, get worse or weakness develops, see a doctor [2]⁠[5].

+When do you need carpal tunnel surgery?

Surgery is considered when symptoms continue despite splints and injections, when they are severe, or when tests show significant nerve damage or the thumb muscles are wasting. The decision depends on symptom severity and patient preference [1]⁠[3]⁠[4].

+How soon can I use my hand after carpal tunnel surgery?

The hand can usually be used for light tasks within a few days. Returning to normal daily activities often takes a few weeks, and full grip strength may take several months [1]⁠[2]⁠[3].

+Do I need an EMG for carpal tunnel syndrome?

Not always. The diagnosis is usually made by examination; nerve conduction studies and EMG may be requested if the diagnosis is unclear, to judge severity, or before surgery [1]⁠[3].

Sources

  1. [1]Carpal Tunnel Syndrome — American Academy of Orthopaedic Surgeons (OrthoInfo).
  2. [2]Carpal tunnel syndrome — NHS (nhs.uk), 2024.
  3. [3]Carpal Tunnel Syndrome — British Society for Surgery of the Hand (BSSH).
  4. [4]Surgical versus non-surgical treatment for carpal tunnel syndrome (Cochrane Review) — Cochrane Database of Systematic Reviews (Lusa V, et al.), 2024.
  5. [5]Splinting for carpal tunnel syndrome (Cochrane Review) — Cochrane Database of Systematic Reviews (Karjalainen TV, et al.), 2023.
  6. [6]Surgery versus corticosteroid injection for carpal tunnel syndrome (DISTRICTS): an open-label, multicentre, randomised controlled trial — The Lancet (Palmbergen WAC, et al.), 2025.

This article is general information and does not replace an examination or personal medical advice. In an emergency, go to the nearest emergency department.