Carpal Tunnel Syndrome: Symptoms, Causes, and Relief

Carpal tunnel syndrome (CTS) is a common condition that cause numbness, tingling, and pain in the hand and arm. The condition occurs when one of the major nerves to the hand—the median nerve—is squeezed or compressed as it travels through the wrist.

The carpal tunnel is a narrow passageway on the palm side of your wrist made of bones and ligaments. The median nerve controls sensations to the palm side of your thumb and fingers (except the little finger) and provides signals to move the muscles around the base of your thumb. In many cases, CTS worsens over time, so early diagnosis and treatment are essential for long-term hand health.

The symptoms of carpal tunnel syndrome usually start gradually and may come and go at first. Because many people sleep with their wrists flexed, symptoms are often worse at night and may wake you from sleep.

• Tingling and numbness: You may notice a sensation like 'pins and needles' in your thumb and fingers. It specifically affects the thumb, index, middle, and half of the ring finger, but never the little finger.
• Weakness: You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles.
• Radiating pain: A burning or aching sensation that may travel up the forearm toward the shoulder.

In most cases, carpal tunnel syndrome is caused by a combination of factors rather than a single event. It is more common in women and older adults. Primary contributors include:

• Genetics: Some people naturally have a smaller carpal tunnel, which may run in families.
• Repetitive hand use: Repeating the same hand and wrist motions over a long period may aggravate the tendons in the wrist, causing swelling that puts pressure on the nerve.
• Health conditions: Diabetes, rheumatoid arthritis, and thyroid gland imbalance are associated with CTS.
• Pregnancy: Hormonal changes during pregnancy can cause fluid retention, leading to swelling and pressure in the carpal tunnel. Symptoms usually resolve after birth.

If your symptoms are mild, you may be able to manage them at home. The NHS recommends several conservative approaches to reduce pressure on the median nerve:

• Wrist splints: Wearing a wrist splint at night keeps the wrist in a neutral position, preventing it from bending while you sleep. This is often the first line of treatment.
• Activity modification: If your symptoms are triggered by specific tasks, try to take frequent breaks or change the way you use your hands.
• Pain relief: Over-the-counter anti-inflammatory drugs (NSAIDs) like ibuprofen may help ease pain, though they rarely cure the underlying compression.
• Hand exercises: Specific 'nerve gliding' exercises can help the median nerve move better within the carpal tunnel.

If home remedies do not provide relief, medical intervention may be necessary. A healthcare professional may suggest:

• Corticosteroid injections: A doctor may inject the carpal tunnel with a steroid to reduce inflammation and swelling, which relieves pressure on the median nerve.
• Surgery: If symptoms are severe or persistent, a procedure called 'carpal tunnel release' may be recommended. This involves cutting the ligament that forms the roof of the tunnel to increase the size of the tunnel and decrease pressure on the nerve.

While mild carpal tunnel symptoms can sometimes improve with rest, you should consult a GP if the symptoms are interfering with your daily activities or sleep. An online GP can assess your symptoms, provide advice on using wrist splints, and discuss medication options.

Speaking with a GP early is particularly important if you notice physical changes, such as the muscles at the base of your thumb looking smaller (wasting), or if you have a persistent loss of feeling, as this may indicate more significant nerve compression that requires a specialist referral.