What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a peripheral nerve condition caused by compression of the median nerve as it travels through the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by wrist bones and the transverse carpal ligament.

The median nerve helps provide feeling to the thumb, index finger, middle finger, and part of the ring finger. It also helps control some muscles at the base of the thumb. When the median nerve is compressed, patients may develop numbness, tingling, burning pain, hand weakness, or trouble gripping objects.

De Novo Brain & Spine evaluates adult patients with suspected or confirmed carpal tunnel syndrome to help determine the appropriate next step. Evaluation may include neurological examination, review of symptoms, electrodiagnostic testing such as EMG and nerve conduction studies, conservative care recommendations, or surgical treatment planning when appropriate.

Common Signs and Symptoms

Carpal tunnel syndrome symptoms often develop gradually. Symptoms may be worse at night, during driving, while holding a phone, or during activities that involve wrist position or repetitive hand use.

Common signs and symptoms may include:

• Numbness or tingling in the thumb, index finger, middle finger, or part of the ring finger
• Burning, aching, or electric-like pain in the hand or wrist
• Symptoms that wake a person from sleep
• Hand symptoms that improve temporarily after shaking the hand
• Pain or tingling that may travel from the wrist into the forearm
• Weak grip strength
• Dropping objects
• Trouble buttoning clothing, writing, typing, or handling small objects
• Thumb weakness
• Shrinking or wasting of the thumb muscles, called thenar atrophy, in more advanced cases
• Symptoms in one or both hands

Seek prompt medical evaluation for progressive hand weakness, visible muscle wasting at the base of the thumb, constant numbness, loss of hand function, or symptoms that do not improve with appropriate conservative care.

What Causes This Condition?

Carpal tunnel syndrome occurs when pressure increases around the median nerve inside the carpal tunnel. In many patients, more than one factor may contribute.

Possible causes and risk factors may include:

• Wrist anatomy or a naturally smaller carpal tunnel
• Repetitive hand or wrist activity in some patients
• Prolonged wrist flexion or extension
• Swelling or inflammation around the wrist tendons
• Wrist fracture, arthritis, or prior wrist injury
• Diabetes or other metabolic conditions that can affect nerves
• Thyroid disease
• Rheumatoid arthritis or other inflammatory conditions
• Pregnancy or fluid retention
• Obesity
• Kidney disease or dialysis-related factors in selected patients

These are causes or risk factors, not guarantees that carpal tunnel syndrome will occur. Treatment planning depends on symptom severity, neurological examination, electrodiagnostic findings, medical history, work or activity demands, and the patient’s overall health.

How It Is Diagnosed?

Carpal tunnel syndrome is diagnosed through medical history, physical examination, and sometimes nerve testing. The evaluation also helps distinguish carpal tunnel syndrome from other conditions, such as cervical radiculopathy, ulnar neuropathy, or peripheral neuropathy.

Common diagnostic steps may include:

• Medical history and symptom review to understand numbness, tingling, pain, weakness, nighttime symptoms, hand use, and symptom duration
• Neurological examination to evaluate sensation, strength, reflexes, hand function, and thumb muscle bulk
• Median nerve testing at the wrist, including physical exam maneuvers that may reproduce symptoms
• Electromyography, also called EMG, to evaluate muscle and nerve function when needed
• Nerve conduction studies, also called NCS, to measure how well the median nerve carries electrical signals across the wrist
• Ultrasound of the median nerve in selected cases when nerve swelling or anatomy needs evaluation
• X-rays or other imaging in selected cases when arthritis, fracture, or another structural wrist problem is suspected
• Evaluation for other nerve conditions when symptoms do not fit typical carpal tunnel syndrome or involve the whole hand, arm, neck, or both sides of the body

The goal of diagnosis is to confirm whether the median nerve is compressed at the wrist, determine the severity of nerve involvement, and identify whether non-surgical care or surgical evaluation may be appropriate.

Treatment Options

Carpal tunnel syndrome treatment depends on symptom severity, duration, nerve testing results, hand weakness, medical conditions, activity demands, and response to prior treatment. Not every patient needs surgery.

Treatment options may include:

• Wrist splinting, especially at night, to keep the wrist in a neutral position and reduce pressure on the median nerve
• Activity modification to reduce positions or tasks that worsen symptoms
• Hand therapy or occupational therapy when appropriate to improve function, reduce irritation, and support safe activity changes
• Nerve-gliding or tendon-gliding exercises when recommended by a clinician or therapist
• Anti-inflammatory medication for short-term pain relief when medically appropriate, although medication does not correct severe nerve compression
• Corticosteroid injection into the carpal tunnel in selected cases to reduce inflammation and symptoms
• Treatment of contributing medical conditions, such as diabetes, thyroid disease, inflammatory arthritis, or fluid retention when relevant
• Carpal tunnel release surgery when symptoms are severe, persistent, progressive, associated with weakness or thenar atrophy, or not improving with appropriate conservative care
• Open or endoscopic carpal tunnel release in selected cases, depending on surgeon assessment and patient-specific factors
• Follow-up after treatment to monitor symptom improvement, hand strength, and nerve recovery when appropriate

The purpose of carpal tunnel release surgery is to reduce pressure on the median nerve by releasing the transverse carpal ligament. Surgical treatment may be considered when nerve compression is significant or when ongoing symptoms threaten hand function.