Carpal Tunnel Syndrome

If your hand wakes you up at night feeling numb, tingly or on fire, carpal tunnel syndrome is one of the first things to think about. It is the most common pinched-nerve problem in the body, and very treatable once you know what you're dealing with.

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is compression of the median nerve as it passes through the carpal tunnel — the narrow passage at the base of the palm formed by wrist bones and the transverse carpal ligament. The median nerve supplies sensation to the thumb, index, middle, and half the ring finger, and it powers the thenar muscles at the base of the thumb.

CTS affects roughly 3–5% of adults. It is more common in women, during pregnancy, and in people with diabetes, thyroid disease or rheumatoid arthritis.

At a Glance

The most common entrapment neuropathy — affecting roughly 3-5% of adults
Classic symptoms: night-time numbness and tingling in the thumb, index and middle fingers
Night splints and steroid injection work for mild cases but benefit is often short-lived
Carpal tunnel release surgery is safe, brief and highly effective
Most patients return to light activity within 1-2 weeks after surgery

Symptoms

Early symptoms

Numbness or tingling in the thumb, index and middle fingers
Symptoms that wake you up at night; shaking out the hand relieves them
Numbness when driving, holding a phone or reading
A feeling the hand is asleep or on fire
Dropping small objects like keys or coins

Later symptoms

Constant numbness even during the day
Weakness when pinching or gripping
Loss of thenar muscle bulk at the base of the thumb
Difficulty with buttons, small tools or fine motor tasks

Diagnosis

Physical examination
Tinel's sign (tapping over the carpal tunnel elicits tingling), Phalen's test (sustained wrist flexion for 1 minute), thenar muscle strength and atrophy.

Nerve conduction studies and EMG
Measures how fast electrical signals travel across the carpal tunnel. Confirms CTS and grades severity (mild, moderate, severe). Rules out cervical radiculopathy or more proximal entrapment.

MRI of wrist — rarely needed; used when tumor, ganglion, or unusual cause is suspected

Types

Treatment

Non-surgical — for mild to moderate CTS

Nighttime wrist extension splint — most evidence-backed initial treatment; keeps wrist neutral while sleeping
Steroid injection — provides meaningful relief in ~70% of patients short-term; benefit often fades within 3-12 months
Activity modification and ergonomic changes

Carpal tunnel release — when conservative care fails or severe disease

The transverse carpal ligament is divided — either through a 1-2 inch open incision or a small camera (endoscopic). Both are outpatient operations under local anesthesia, taking 15-20 minutes.
Endoscopic has slightly faster return to work; open is preferred for revision or complex anatomy. Relief of night symptoms typically occurs within days.

Outcomes

Treatment	Symptom improvement	Return to work	Notes
Night splinting alone	~40-60% at 3 months	N/A	Best for mild cases; recurrence common
Steroid injection	~70% at 1 month	N/A	Fades; ~50% need surgery within 5 years
Open release	~85-90% at 1 year	2-6 weeks	Symptom relief often immediate
Endoscopic release	~85-90% at 1 year	1-3 weeks	Faster return to work; same long-term outcome

References

Keith MW, et al. Clinical practice guideline on the diagnosis of carpal tunnel syndrome. J Am Acad Orthop Surg. 2009;17:392-398. PMID: 19474449
Gerritsen AA, et al. Splinting vs surgery in the treatment of CTS. JAMA. 2002;288:1245-1251. PMID: 12215131
Benson LS, et al. The outcome of carpal tunnel release with and without internal neurolysis of the median nerve. J Hand Surg Am. 2006;31:69-73. PMID: 16443106
Thoma A, et al. Comparison of open and endoscopic carpal tunnel release. Can J Surg. 2004;47:100-104. PMID: 15132460

Our Specialists

P.B. Raksin, MD

Neurosurgery

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