What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome (CTS) is a common nerve disorder caused by compression of the median nerve as it passes through the carpal tunnel in the wrist. It can cause numbness, tingling, burning pain and weakness, particularly in the thumb, index and middle fingers and part of the ring finger. Symptoms often become more noticeable at night or during activities that keep the wrist bent for prolonged periods. If compression continues for a long time, it can result in muscle weakness and permanent sensory or functional changes.

Carpal Tunnel Syndrome develops when pressure increases within the narrow wrist passage that surrounds the median nerve.

Repetitive hand movements or prolonged wrist positions can aggravate symptoms, although current evidence does not establish keyboard use alone as a direct cause of CTS.

• Numbness or tingling in the thumb, index and middle fingers

• Pain or burning that may travel into the forearm

• Symptoms that worsen at night

• Difficulty gripping objects or performing fine movements

• Weakness or wasting of the thumb muscles in advanced cases

Carpal Tunnel Syndrome and wrist or hand arthritis can both cause pain and difficulty using the hand, but they affect different structures.

CTS primarily affects a nerve, producing numbness, tingling and altered sensation in the median nerve distribution. Arthritis affects joints, more commonly causing joint pain, stiffness, swelling and reduced range of motion. Rheumatoid arthritis can also contribute to CTS because inflammation and swelling around the wrist can increase pressure within the carpal tunnel.

Persistent numbness, night-time symptoms or weakness should therefore not automatically be attributed to arthritis.

The most common symptoms of Carpal Tunnel Syndrome are numbness, tingling and burning sensations in the thumb, index finger, middle finger and part of the ring finger. Symptoms may initially come and go but can become more frequent as nerve compression progresses.

Many people notice symptoms while sleeping or wake up needing to shake or move the hand to relieve the sensation. Activities such as driving, holding a phone or reading a book may also trigger symptoms when the wrist remains in one position for a prolonged period.

Persistent numbness or weakness should not be ignored, as prolonged median nerve compression can cause more lasting nerve damage.

Diagnosis usually begins with a medical history and physical examination. A clinician may assess sensation, grip strength, thumb movement and whether certain wrist positions reproduce symptoms.

Clinical tests such as the Phalen test and Tinel test may be used as part of the examination, although no single physical test can reliably confirm or rule out CTS on its own.

When the diagnosis is uncertain, symptoms are severe, or surgery is being considered, nerve conduction studies and electromyography (EMG) may be recommended. These tests assess how effectively electrical signals travel through the median nerve and can help determine the severity of nerve compression.

Ultrasound may also be used in some cases to examine the median nerve and structures within the carpal tunnel.

Treatment depends on the severity and duration of symptoms. Mild cases may initially be managed without surgery, while significant nerve compression may require more definitive treatment.

• Night-time wrist splinting: Keeps the wrist in a neutral position and may reduce symptoms during sleep.

• Activity modification: Reducing activities that repeatedly aggravate symptoms can help limit irritation.

• Physiotherapy: Selected nerve and tendon-gliding exercises may be used in appropriate cases.

• Corticosteroid injection: May provide short-term symptom relief in some patients, although it does not permanently address the underlying compression.

Treatment should be guided by the severity of nerve involvement rather than symptoms alone.

Ergonomic adjustments can be particularly useful for people who spend long hours at a desk. The aim is to avoid sustained wrist flexion or extension and reduce unnecessary pressure on the wrist.

A workstation can be adjusted so that the keyboard and mouse are easy to reach and the wrists remain in a relatively neutral position. Regular breaks, changing hand positions and avoiding prolonged pressure against the edge of a desk may also help reduce symptom aggravation.

Ergonomics can support symptom management, but it should not be considered a standalone treatment for established Carpal Tunnel Syndrome.

Nerve-gliding and tendon-gliding exercises are sometimes included in conservative treatment. These movements are designed to encourage the median nerve and tendons to move freely within and around the carpal tunnel.

Exercises should be gentle. If a movement increases numbness, tingling or pain, it should be stopped and reviewed by a healthcare professional. Exercise selection is best individualised according to the severity and cause of nerve compression.

Surgery may be considered when symptoms do not improve with appropriate conservative treatment, significantly affect daily activities or when tests show substantial median nerve compression.

Surgery becomes particularly important when there is progressive weakness, persistent sensory loss or wasting of the thumb muscles, as these can indicate more advanced nerve damage.

The most common procedure is carpal tunnel release, which cuts the ligament forming the roof of the carpal tunnel to create more space for the median nerve. Both open and endoscopic techniques are used, with the choice depending on clinical circumstances and surgeon preference.

Not every case of Carpal Tunnel Syndrome can be prevented because factors such as anatomy, diabetes, pregnancy, inflammatory conditions and previous wrist injuries can increase risk.

However, maintaining neutral wrist positions, avoiding prolonged pressure on the wrist and addressing underlying conditions that contribute to nerve compression may help reduce risk or prevent symptoms from becoming worse.

In addition, cannabinoid-based medications are also being explored for their potential role in treating neuropathic pain, but these should always be considered under the guidance of a medical expert. 

Early evaluation is important when numbness or tingling persists, because treating the condition before significant nerve damage develops generally offers better prospects for recovery.