Carpal Tunnel Syndrome Treatment
Compression of the median nerve at the wrist causes numbness, tingling and weakness in the fingers. Splints and exercise help early on, and a small operation is effective in later stages.
Carpal tunnel syndrome is compression of the median nerve in the carpal tunnel, a narrow channel on the palm side of the wrist formed by bones and a thick ligament (the transverse carpal ligament). It is the most common nerve compression condition. It is more frequent in women, during pregnancy, in people with diabetes or thyroid disease and in those who use their wrists heavily.
Symptoms
- Numbness and tingling in the thumb, index, middle and half of the ring finger
- Numbness that wakes you at night and eases when you shake your hand
- Symptoms that worsen when holding a phone, driving or reading
- Clumsiness, difficulty with buttons, dropping things
- In later stages, wasting of the muscles at the base of the thumb
Diagnosis
Symptoms brought on by tapping over the wrist (Tinel’s test) or holding the wrist bent (Phalen’s test) support the diagnosis. A nerve conduction study (EMG) shows whether compression is present and how severe it is. Conditions with similar symptoms, such as a neck disc problem, are ruled out.
Non-surgical treatment
For mild and moderate cases:
- A splint that keeps the wrist straight, especially at night
- Reducing movements that strain the wrist and adjusting work ergonomics
- Nerve gliding exercises
- An injection into the carpal tunnel in suitable patients
- Controlling underlying diabetes or thyroid disease
Carpal tunnel syndrome caused by pregnancy often improves after birth.
Surgery: carpal tunnel release
Surgery is recommended when non-surgical treatment does not help, EMG shows moderate or severe compression, or muscle wasting has started. It is usually done under local anaesthesia and takes a short time. Through a small incision in the palm, the transverse carpal ligament pressing on the nerve is divided to widen the tunnel. An endoscopic technique may be used in selected patients.
Recovery
- Patients go home the same day.
- Night-time numbness usually eases markedly in the first days.
- The fingers are moved straight after surgery.
- Stitches are removed after about 10-14 days.
- Grip strength returns over a few weeks to a few months.
- In long-standing, severe compression, sensation takes longer to recover.
Carpal tunnel syndrome in pregnancy
During pregnancy the body retains more fluid and pressure in the carpal tunnel can rise, so hand numbness is common, especially in the last months. A night splint and avoiding straining wrist movements are usually enough, and symptoms tend to ease in the weeks and months after birth.
At work
Positioning the keyboard and mouse so the wrist is not bent, taking frequent breaks when using vibrating tools, and changing position often in jobs that keep the wrist bent or tense for long help reduce symptoms.
Frequently asked questions
Does the numbness go away right after surgery?
Night-time numbness usually eases quickly. In long-standing severe compression, full nerve recovery can take months.
Can both hands be operated on at the same time?
It is possible, but most patients prefer separate operations so daily tasks stay manageable.
Can it come back?
Recurrence after a properly performed release is rare.
Will my wrist hurt after surgery?
The scar in the palm may be tender for a few weeks. This eases over time and most patients return to daily tasks quickly.
What happens if carpal tunnel syndrome is not treated?
Long-standing untreated compression can cause permanent nerve damage, lasting numbness and wasting of the muscles at the base of the thumb.
The information on this page is general and does not replace an examination. An examination is needed to decide which treatment suits you.