In carpal tunnel syndrome (CTS), the median nerve becomes squeezed as it passes a narrow passageway that the bones and ligaments form in the wrist. A common early symptom of CTS is intermittent numbness or tingling in the hand.

These symptoms may become more frequent or persistent as time passes. A person may also notice other issues, such as muscle weakness in the hand.

This article outlines the early signs of CTS and offers guidance on what to do if these signs occur. It also provides information on how doctors diagnose and treat CTS. Finally, it answers some common questions about CTS.

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CTS is a condition affecting the median nerve, which runs through the wrist to the hand.

According to the American Society of Surgery to the Hand (ASSH), the main symptom of CTS is numbness or tingling in the following parts of the hand:

  • the thumb
  • the index and middle fingers
  • all or half of the ring finger

The ASSH states that these symptoms typically come on gradually and intermittently across months or years. They may only occur at certain times of the day or with certain activities or wrist positions.

The numbness and tingling are often worse at night, and a person may find relief when they shake their hand or wrist.

As CTS worsens, the numbness may become constant. The speed with which the condition worsens varies from person to person. For some, it may be gradual and almost unnoticeable. For others, it may be sudden.

Other signs and symptoms

According to the American Academy of Orthopaedic Surgeons (AAOS), other symptoms of CTS may include:

  • occasional shock-like sensations that radiate to the thumb, index, middle, and ring finger
  • pain or tingling that radiates up the forearm
  • weakness of the hand, which may lead to the following:
    • difficulty performing fine motor movements, such as buttoning clothes
    • difficulty pinching or gripping
    • increased tendency to drop items
  • loss of hand proprioception, which refers to a person’s awareness of where their hand is in space

As the American Academy of Rheumatology (AAR) explains, the symptoms of CTS may be mild at first, so a person may not seek immediate treatment.

The AAR recommends that people with mild CTS try the following over-the-counter (OTC) treatments. These interventions include wearable splints and OTC pain relief medications, such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs).

Splints are devices that help keep the wrist in a straight or neutral position, which alleviates pressure on the median nerve.

If the above treatments do not ease CTS, a person needs to consider consulting a doctor for a diagnosis and additional treatment. The condition may progress without further treatment, causing muscle weakness and a loss of function.

The AAOS states that seeking an early diagnosis and treatment for CTS can help slow the disease and may even prevent it from progressing.

The United Kingdom’s National Health Service (NHS) recommends that people consult a doctor if their CTS symptoms persist or worsen despite home treatments.

When diagnosing CTS, a doctor will ask about a person’s general health, medical history, and current symptoms.

According to the AAOS, the doctor will then examine the hand and wrist and ask the person to perform a series of physical tests. During these tests, the doctor may:

  • apply pressure to, or tap on, the median nerve on the underside of the wrist to see if it causes tingling in the fingers
  • bend and hold the wrists in a flexed position to see if it causes numbness or tingling in the hands
  • lightly touch the hands and fingertips using a special instrument to check for sensitivity
  • check for muscle weakness and decline around the base of the thumb

The doctor may then request additional tests, such as:

  • Electrophysiological tests: These help assess median nerve function and levels of nerve compression. Examples include:
    • A nerve conduction study: This test measures nerve signaling in the hand and arm. It helps doctors determine the severity of CTS and formulate an appropriate treatment plan.
    • An electromyogram: This test measures electrical activity in the muscles and can help detect nerve and muscle damage.
  • Imaging tests: These help doctors view the structures inside the wrist. Examples include:
    • Ultrasound: Uses high-frequency sound waves to build up a picture of the body’s tissues. It can detect signs of median nerve compression.
    • X-ray: These show dense structures, such as bone. Doctors may recommend this test to rule out other causes of wrist pain, such as fractures and arthritis.
    • MRI: Can detect issues with nerves and other soft tissues. Doctors may also use it to look for issues that could be affecting the median nerve, such as scarring from an injury.

The main purpose of treatment for CTS is to ease or remove pressure on the median nerve. Nonsurgical treatments that can help reduce inflammation and associated nerve pressure include:

  • wearing wrist splints
  • taking NSAIDs
  • avoiding or modifying activities that aggravate CST symptoms
  • practicing nerve gliding exercises, which help the median nerve move more freely inside the carpal tunnel
  • receiving a cortisone injection into the carpal tunnel

If the above treatments are ineffective or only provide temporary relief, doctors may recommend a surgical procedure called carpal tunnel release.

This involves cutting the ligament that forms the roof of the carpal tunnel to create more space for the median nerve. The surgery aims to restore proper nerve function and alleviate CTS symptoms.

Below are some answers to common questions about CTS.

Are there stages of carpal tunnel syndrome?

There are no distinct stages of CTS. However, the symptoms typically develop slowly and may initially come and go. As the condition worsens, the symptoms may become more frequent or may persist for longer.

How does carpal tunnel syndrome begin?

CTS begins when the median nerve becomes pressed or squeezed at the wrist. Various factors can cause CTS, such as injury to the wrist, repeated use of vibrating machinery, or underlying medical conditions.

Initially, CTS typically presents as numbness or tingling in the thumb or fingers.

How can a person check themselves for carpal tunnel syndrome?

The Phalen test is a maneuver that people can perform at home to check for signs of CTS.

According to the National Library of Medicine (NLM), the test involves pushing the backs of the hands together so that the fingers are pointing downward. A person then holds this position for 30 to 60 seconds, which increases pressure in the carpal tunnel.

Pain or tingling in the thumb, index finger, or middle finger while performing the Phalen test may indicate CTS. However, a person may consider consulting a doctor for an accurate diagnosis.

What other conditions might be mistaken for carpal tunnel syndrome?

When diagnosing CTS, doctors may want to rule out other conditions that can cause similar symptoms. These include ligament injury, bone fracture, nerve damage, arthritis, and nerve pain from other conditions, such as diabetes.

Carpal tunnel syndrome (CTS) is a condition in which the median nerve that runs through the wrist becomes compressed. This can cause symptoms such as numbness or tingling in the thumb or fingers.

Symptoms of CTS typically develop gradually. They may be intermittent at first and become more frequent or persistent as time goes on.

As the condition progresses, a person may notice other signs and symptoms, such as muscle weakness that affects a person’s ability to pinch, grip, or perform fine motor movements.