Carpal tunnel syndrome: symptoms, treatment, causes and recovery

The NHS lists the symptoms of carpal tunnel syndrome (CTS) as follows. They often start slowly and come and go, and they are usually worse at night.

NICE CKS describes the area affected as the part of the hand supplied by the median nerve: the thumb, index finger, middle finger and the thumb side of the ring finger. CKS says that in severe disease there can be wasting of the thenar muscles (the muscles at the base of the thumb), sensory loss, and reduced hand grip and pinch strength.

• An ache or pain in your fingers, hand or arm.

• Numb hands.

• Tingling or pins and needles.

• A weak thumb or difficulty gripping.

The NHS says CTS can often be treated yourself, though it can take months to get better. NICE CKS says that for mild or moderate symptoms, clinicians should offer a 6-week trial of conservative treatment, with review after 6 weeks if symptoms persist.

The NHS says CTS sometimes gets better by itself in a few months, particularly if you have it because you are pregnant. NICE CKS says symptoms may resolve spontaneously in some people.

CKS reports one study of untreated people followed for an average of 2 years, in which symptoms resolved in 47.6% on patient questionnaires, remained stable in 28.8% and worsened in 23.4%. It describes short duration of symptoms, young age and CTS due to pregnancy as good prognostic signs, and bilateral symptoms as a poor sign. It also says CTS linked with diabetes or a previous wrist fracture often has a less favourable outlook.

CKS says approximately 70% to 90% of mild-to-moderate cases respond to conservative management, although many people may progress to the point where surgery becomes necessary.

The NHS says it happens when the carpal tunnel inside your wrist swells and squeezes one of your nerves, the median nerve. NICE CKS describes it as the most common entrapment neuropathy of the upper limb, caused by compression of the median nerve in the carpal tunnel, which leads to pain and pins and needles in the area the nerve supplies.

NICE CKS says that the majority of cases have no known underlying cause. The NHS and CKS list the following factors that may increase your risk.

CKS adds that there is a lack of consistent evidence in the literature linking CTS to computer work.

• Being overweight (NHS, CKS).

• Pregnancy. CKS says there is an increased incidence compared with non-pregnant women.

• Work or hobbies that mean repeatedly bending your wrist or gripping hard, such as using vibrating tools (NHS); CKS also mentions gardening, assembly line work and occupations requiring forceful or repetitive grip.

• Conditions such as arthritis or diabetes (NHS). CKS lists rheumatoid arthritis, osteoarthritis of the thumb joint, hypothyroidism and diabetes mellitus.

• Having a parent, brother or sister with CTS.

• A previous wrist injury.

The NHS lists being pregnant as a risk factor and says CTS sometimes gets better by itself in a few months, particularly if you have it because you are pregnant. NICE CKS says there is an increased incidence of CTS in pregnancy, thought to be a consequence of increased volume in the tunnel following a change in fluid balance, and lists CTS due to pregnancy among the good prognostic indicators.

The self-help steps in the NHS guidance, such as a night wrist splint, are worth asking your midwife or GP about if symptoms are troubling you. See a GP if symptoms are getting worse or are not going away.

The NHS says CTS can usually be diagnosed by asking about your symptoms and checking your hand. If the health professional is not sure it is CTS, they may refer you to hospital for a test of the nerves in your wrist (a nerve conduction test) or scans such as an ultrasound scan or MRI scan.

NICE CKS says nerve conduction studies may be considered if the diagnosis is uncertain or surgery is planned, and that a normal result does not exclude CTS. It also advises considering further investigations if an underlying cause is suspected.

The NHS says that if CTS is getting worse and other treatments have not worked, you might be referred to a specialist to discuss surgery. You and your specialist decide together if it is the right treatment.

The NHS describes the operation: an injection numbs your wrist (local anaesthetic) and a small cut is made in your hand. The carpal tunnel is cut so it no longer puts pressure on the nerve. It takes around 20 minutes, you do not have to stay in hospital overnight, and it can take a month to get back to normal activities.

NICE CKS says open and endoscopic techniques have similar outcomes. It lists the risks of surgery as a sensitive scar, neurovascular damage and complex regional pain syndrome, and says serious complications such as tendon or nerve damage occur in fewer than 2% of procedures. It reports a success rate between 80% and 95%, with a further procedure needed in 3% to 5%.

The NHS says to see a GP if your CTS symptoms are getting worse or are not going away, or if treatment at home is not working. In many areas you may be able to get help, such as physiotherapy, from NHS community musculoskeletal (MSK) services without needing a GP referral.

NICE CKS says a specialist referral is appropriate if the diagnosis is unclear, symptoms persist despite a trial of conservative treatment, symptoms are progressive or severe disease is affecting daily function, or symptoms recur or persist after surgery.

On the NHS, CTS is usually assessed and treated through your GP or a community MSK service, with referral to a hospital hand or orthopaedic team if surgery is being considered. Splints can be bought online or from pharmacies, as the NHS notes.

Some people choose to see a private hand or orthopaedic surgeon for quicker assessment or surgery. Whichever route you take, it is reasonable to ask which type of release will be used, what recovery to expect and who to contact if the wound or hand gives you concern afterwards, and to keep your GP informed.