Medical condition
Carpal Tunnel Syndrome
Carpal tunnel syndrome causes numbness and tingling in the thumb, index and middle fingers, worst at night. Night splinting and injection resolve or improve most mild to moderate cases. Constant numbness or muscle wasting indicates nerve damage and needs prompt surgical assessment.
The pattern, and why night is worst
Numbness and tingling in the thumb, index, middle and half the ring finger, waking you at night and often relieved by shaking the hand. Symptoms with driving, holding a phone or a book. Clumsiness and dropping things as it progresses.
The wrist tends to bend during sleep, which raises pressure in the carpal tunnel. This is why night splinting in a neutral position is effective and why the diagnosis is often clear from the history alone.
The signs that mean do not wait
Numbness that is constant rather than intermittent. Visible wasting of the muscle bulge at the base of the thumb. Weakness of thumb opposition.
These indicate established nerve damage. Surgery at this stage relieves symptoms but recovery of sensation and strength is incomplete, and it becomes less complete the longer it is left.
What conservative treatment achieves
Night splinting in a neutral wrist position resolves or substantially improves a large proportion of mild to moderate cases. Corticosteroid injection into the carpal tunnel adds further benefit and can be diagnostic as well as therapeutic.
Nerve and tendon gliding exercises, activity modification and workstation adjustment support these. A sustained trial of these measures is worthwhile before judging whether they have worked.
Surgery and what follows it
Carpal tunnel release is highly effective where conservative treatment fails or where there is nerve damage. It is a short procedure and most people return to light activity within days.
Rehabilitation afterwards focuses on scar management, nerve gliding and graded return to grip loading. Persistent numbness after surgery usually reflects how long the nerve was compressed before it.
How the diagnosis is confirmed
The history does most of the work: numbness in the thumb, index and middle fingers, worst at night, relieved by shaking the hand. Examination adds sensory testing, grip and thumb strength, and provocation tests.
Nerve conduction studies are used where the picture is unclear, where symptoms could be coming from the neck instead, or before surgery. They are not needed in every case, and a normal study in someone with a classic history does not rule the condition out.
Splinting, done properly
A night splint holds the wrist in a neutral position, because the pressure inside the carpal tunnel rises when the wrist is bent in either direction — and most people sleep with it bent. Worn consistently, this is among the most effective conservative measures.
Two things make splinting fail: a splint that holds the wrist in extension rather than neutral, and wearing it for a week and stopping. It needs several weeks to show what it can do.
What an injection does, and for how long
A corticosteroid injection into the carpal tunnel reduces symptoms in most people, often substantially. The effect is frequently temporary, and symptoms return in a proportion of cases over the following months.
That makes it useful in two situations: when symptoms need to settle so that hand therapy can proceed, and as a diagnostic pointer — a clear response supports the diagnosis before a decision about surgery. It is not a substitute for surgery where there is established nerve damage.
Keyboards, work, and a persistent myth
The association between ordinary computer use and carpal tunnel syndrome is far weaker than public belief suggests. Forceful, repetitive gripping and prolonged vibration exposure are the occupational factors with better support.
This matters practically: people spend months changing keyboards and mice while the actual contributors — pregnancy, thyroid disease, diabetes, rheumatoid arthritis, wrist fracture — go unaddressed. We look for those.
Frequently asked questions
Will it get better on its own?
Mild, intermittent symptoms sometimes settle, particularly when there is a temporary cause such as pregnancy. Constant numbness does not resolve on its own and indicates that the nerve is under sustained pressure.
What are the signs I should not wait?
Numbness that is present all the time rather than coming and going, weakness or wasting of the muscle at the base of the thumb, and dropping objects. These indicate nerve damage that does not fully recover once established, and they warrant surgical assessment rather than another course of conservative treatment.
How successful is the surgery?
Carpal tunnel release relieves night symptoms reliably and is among the more predictable operations in hand surgery. Recovery of sensation and strength is slower and less complete when the nerve has been compressed for a long time — which is the argument for not waiting once the warning signs appear.
Do I need therapy after surgery?
Often a short course: scar management, tendon and nerve gliding, grip strengthening and a graded return to work. Not everyone needs it, but people with heavy manual jobs or a stiff hand beforehand generally do.
Can it affect both hands?
Frequently, though usually not equally. Bilateral symptoms, particularly with other joint involvement, make it worth looking for an underlying cause rather than treating each wrist as a separate problem.
Is it caused by my job?
Sometimes contributed to, rarely caused outright. Forceful repetitive gripping and vibrating tools have reasonable evidence; ordinary keyboard work has weak evidence. Where work is a factor we address it, but not at the expense of looking for medical contributors.
Sources
- Shapiro LM, et al. American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary: Management of Carpal Tunnel Syndrome — Journal of the American Academy of Orthopaedic Surgeons (2025)
Which therapies would I actually receive?
A therapy is a single method used inside a programme. It is measured in sessions and is not sold separately.
Technologies we use
Locations
Where you can receive this treatment
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