It is often associated with repetitive movements or trauma and is more common in women between the ages of 30 and 50. In most patients, symptoms gradually worsen, and if not treated properly, the condition may result in permanent damage to the hand, such as loss of sensation and reduced grip strength. For this reason, early diagnosis and treatment of carpal tunnel syndrome are essential. In the early stages, when symptoms are mild, reducing strain on the wrist, wearing a night splint, physiotherapy, and local corticosteroid injections can help. However, when pressure on the median nerve persists, surgery is recommended to prevent permanent damage.
At the wrist, there is a space formed between the carpal bones and the transverse carpal ligament, known as the carpal tunnel. Through this tunnel pass the flexor tendons of the fingers and the median nerve. Since the tunnel is inelastic, any increase in pressure compresses the nerve and causes symptoms. Several factors contribute to the development of carpal tunnel syndrome, the most significant being hand overuse from repetitive movements over long periods, as seen in occupations involving food service, cleaning, or prolonged computer use. Heredity also plays a role, as in some individuals the tunnel is naturally narrower or anatomical variations predispose them to the condition. Additionally, conditions such as diabetes, rheumatologic diseases, hypothyroidism, other hormonal imbalances, and medications causing fluid retention can increase the risk of carpal tunnel syndrome.
The main symptoms of carpal tunnel syndrome include numbness and pain in the distribution of the median nerve, typically affecting the thumb, index, middle, and half of the ring finger. The pain can radiate up the forearm and sometimes to the shoulder. A hallmark sign is nocturnal pain that wakes patients from sleep. Reduced sensation makes fine motor tasks difficult, often causing patients to drop objects. In the early stages, symptoms may appear only occasionally, such as while holding a phone or a book. Over time, numbness becomes more frequent and especially bothersome at night. In advanced stages, muscle atrophy at the base of the thumb occurs, severely impairing hand function.
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The investigation starts with the history and checking for other conditions that may co-exist. In the clinical examination, the sensation of the fingers and the strength of the thumb muscles are checked. There are also two tests done to determine if there is irritation of the median nerve. The first is to hold the wrists in flexion and see if this replicates the numbness and the second is the impact during the course of the median nerve which causes a sensation of an electric current at the site of nerve irritation.
Electrophysiological studies, including electromyography (EMG) and nerve conduction studies, are essential to confirm whether there is nerve dysfunction, its severity, and its cause.
In some cases, X-rays or MRI may be required to rule out trauma or pathological tissues compressing the nerve at the wrist. Less commonly, compression may occur at other sites, such as the elbow or cervical spine roots, producing similar symptoms. Careful investigation is therefore necessary to determine the most appropriate treatment.
In the early stages, when symptoms are mild, conservative treatment is preferred. Improving workplace ergonomics is important to reduce repetitive stress on the wrist, which can ease symptoms and slow progression. Night splints or splints used during work keep the wrist in a neutral position, thereby reducing pressure on the nerve. Corticosteroid injections into the wrist may also provide significant, though temporary, relief during symptom flare-ups.
When conservative management fails, and symptoms become persistent and severe, the risk of permanent nerve damage increases. In such cases, surgical treatment is indicated.
The goal of surgery is to release the median nerve by opening the carpal tunnel. This is achieved through a small incision in the wrist under local anesthesia, cutting the transverse carpal ligament to enlarge the tunnel and relieve pressure. Symptom relief is usually immediate, with pain and numbness often disappearing the very first night after surgery. Afterward, the hand can be used for light activities and personal care while keeping the wound dry.
Return to work depends on job demands, ranging from a few days for light tasks to over a month for heavy manual labor.
Although there is no guaranteed way to prevent carpal tunnel syndrome, awareness of wrist strain is important. Taking steps to reduce forceful hand use and incorporating regular breaks—about 10 minutes every hour—can help. Stretching and extending the fingers during breaks is also beneficial. Avoiding prolonged repetitive movements and maintaining the wrist in a neutral position whenever possible can reduce risk.
Carpal tunnel syndrome causes numbness, pain and weakness in the fingers and wrist.
Diagnosis is based on clinical examination and confirmed by neurophysiological testing.
Treatment starts with splints and physiotherapy. In advanced cases, surgery is required.
Full recovery usually takes about 4 to 8 weeks, depending on the case.
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