Understanding carpal tunnel syndrome
Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through the carpal tunnel — a narrow channel in the wrist formed by bones and a ligament. Symptoms include numbness, tingling and burning in the thumb, index, middle and half of the ring finger, often worse at night, and in advanced cases, weakness and wasting of the thumb muscles.
Risk factors include repetitive hand/wrist use, pregnancy, hypothyroidism, diabetes, rheumatoid arthritis, and wrist fractures. However, many cases occur without a clear predisposing factor. Accurate diagnosis relies on the clinical history, examination (Tinel's sign, Phalen's manoeuvre), and nerve conduction studies when the diagnosis is uncertain or to assess severity.
- Numbness and tingling in thumb, index, middle fingers
- Night symptoms — waking with hand numbness, shaking the hand to relieve it
- Weakness — dropping objects, difficulty with buttons or gripping
- Burning pain radiating up the forearm
- Wasting of the thenar (thumb base) muscles in severe cases
- Symptoms provoked by sustained wrist flexion or extension
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Treatment options
Mild carpal tunnel syndrome often improves with a wrist splint (especially at night), activity modification (reducing sustained wrist positions), and treatment of any underlying contributing conditions (e.g., thyroid dysfunction, diabetes). Corticosteroid injection can provide temporary relief and help confirm the diagnosis.
Moderate to severe carpal tunnel syndrome, or cases not responding to conservative measures, are treated with carpal tunnel release — a procedure that divides the ligament pressing on the nerve, relieving the compression. This can be done as a mini-open or endoscopic procedure. Recovery involves progressive hand use, with most patients returning to desk work within 1–2 weeks and full activity within 6–12 weeks.
| Severity | Features | Recommended approach |
|---|---|---|
| Mild | Intermittent night symptoms, no weakness | Wrist splint, activity modification, observe |
| Moderate | Frequent symptoms, mild weakness, NCS abnormal | Splint, injection, consider surgical release |
| Severe | Constant symptoms, thenar wasting, NCS markedly abnormal | Surgical release recommended |