Carpal Tunnel Syndrome

Carpal tunnel syndrome is pressure on the median nerve as it passes through a tight passage in the wrist. It causes pain, tingling, and numbness in the thumb, index, middle, and half of the ring finger, often worse at night or with specific activities. It is very common, especially in women, and highly treatable when caught early.

Symptoms

• Tingling and numbness in the thumb, index, middle, and ring finger (sparing the little finger).
• Night-time symptoms — waking up to shake the hand out.
• Weakness — dropping things, difficulty with buttons, keys, jar lids.
• Pain that can radiate up the forearm.
• Muscle wasting at the base of the thumb — late sign.
• Often worse with driving, reading a phone, typing, or repetitive hand use.

Risk factors

• Repetitive hand movements — typing, assembly work, cooking, texting.
• Pregnancy — often resolves after delivery.
• Obesity.
• Diabetes, hypothyroidism, rheumatoid arthritis.
• Wrist fracture/arthritis, ganglion cyst.
• Female sex; age 30-60.

Diagnosis

• Clinical examination + specific tests (Phalen's, Tinel's).
• Nerve conduction studies confirm and grade severity.
• Ultrasound — increasingly used.
• Check for associated conditions — diabetes, thyroid.

Treatment

• Activity modification — rest, ergonomic adjustments (keyboard/mouse position, phone use breaks).
• Wrist splints — especially at night; very effective for mild cases.
• NSAIDs — short-term.
• Steroid injection into the carpal tunnel — good temporary relief; may be repeated.
• Physiotherapy, nerve glides.
• Surgery (carpal tunnel release) — for moderate-to-severe cases or when conservative measures fail. Can be open or endoscopic; day-care; typically highly effective.
• Treat underlying condition — thyroid replacement, diabetes control, weight loss.

Left untreated, severe carpal tunnel can cause lasting weakness and sensory loss. The best results come from treating it in the "tingling but not weak" phase — don't dismiss recurring night-time hand tingling.