Carpal tunnel syndrome (CTS) is one of the most common nerve problems in the body. It affects men and women of all ages, but it's especially common in people who use their hands intensively at work, during pregnancy, and from middle age on. It's also a major reason for missed work, because it makes typing, gripping and using tools painful.
This guide explains what's going on inside the wrist, who gets carpal tunnel, and the treatments doctors use, from simple splints and stretches to surgery. Looking for gift ideas instead? See our gifts for someone with carpal tunnel pain.
A quick note: we're researchers and gift-givers, not doctors. This article is general information to help you understand the condition. It isn't a substitute for advice from a qualified clinician who can examine your hand.
Hand and wrist anatomy, simply explained
The small bones of the wrist form a curved channel, like a tunnel open at the top. A tough band of tissue, the transverse carpal ligament, roughly the size of a postage stamp and lying deep in the palm, stretches across the top and closes it off.
Through this narrow tunnel run nine tendons that bend the fingers and thumb, plus the median nerve, which carries feeling from the thumb, index, middle and half of the ring finger and powers some of the thumb's muscles.
The key point: the tunnel can't stretch. Anything that takes up extra space inside it, such as swollen tendon linings, fluid or a healed fracture, squeezes the median nerve. That pressure causes the symptoms of carpal tunnel syndrome.
Common symptoms
- Tingling, "pins and needles" or numbness in the thumb, index, middle and part of the ring finger (the little finger is usually spared)
- Symptoms that wake you at night, or are worst first thing in the morning; many people "shake out" their hand for relief
- A dull ache in the wrist that can spread up the forearm toward the elbow, and sometimes to the shoulder
- Stiff, clumsy fingers; trouble with buttons or fine tasks
- In more advanced cases, a weak grip, dropping things, and wasting of the muscles at the base of the thumb
Don't ignore constant numbness or weakness. Symptoms that come and go usually respond well to treatment. Numbness that never goes away, or a thumb that's losing strength, suggests the nerve is under prolonged pressure. Over time that can cause lasting damage, so it's important to see a doctor sooner rather than later.
Who gets carpal tunnel syndrome?
- People who work a lot with their hands, especially with repetitive gripping, bent wrists or vibrating tools.
- Women, who are affected more often than men, possibly because the tunnel tends to be smaller.
- Pregnant women, because fluid retention narrows the space. It often improves after the baby arrives.
- People with diabetes, thyroid problems or rheumatoid arthritis, which can affect nerves or cause swelling in the wrist.
- Weightlifters, whose tendons may thicken with training.
- Anyone who has had a wrist fracture or injury that changed the shape of the tunnel.
- People carrying extra weight, which is linked to a higher risk.
What causes it?
Usually there's no single cause, but a combination of a naturally snug tunnel and things that add pressure inside it:
- Repetitive hand and wrist movements, such as heavy typing, assembly work or crafting
- Holding the wrist bent for long periods, including curling the wrists while asleep
- Swelling of the tendon linings from overuse or inflammation
- Fluid shifts (pregnancy, some medical conditions)
- A previous arm or wrist injury
How is it diagnosed?
Doctors often diagnose carpal tunnel from the pattern of symptoms and a simple hand examination. That might include tapping over the nerve or holding the wrist bent to see whether tingling appears. A nerve conduction study, which measures how fast signals travel along the nerve, may be used to confirm it, gauge severity, or rule out a pinched nerve in the neck, especially before surgery.
Treating carpal tunnel syndrome
Most people start with simple, non-surgical treatments, which work well for mild to moderate symptoms.
1. A wrist splint, especially at night
A splint that holds the wrist straight is one of the most effective first steps, particularly when symptoms are worse at night. It stops the wrist curling into positions that squeeze the nerve while you sleep.
1. Carpal Tunnel Night Wrist Brace
A cushioned brace with a removable splint that keeps the wrist straight while sleeping.
Why it helps: Many people curl their wrists while asleep, which can make numbness and tingling worse. A neutral wrist overnight often helps.
Check price on Amazon2. Changing how you use your hands
Keep wrists straight while typing, take short breaks every 20 to 30 minutes, lighten your grip on pens and tools, and set up the desk so the forearms rest comfortably. Ergonomic tools can help a lot here.
2. Ergonomic Vertical Mouse
A mouse shaped so the hand rests in a 'handshake' position instead of lying flat.
Why it helps: That more natural position takes twisting pressure off the wrist and forearm during long computer days.
Check price on Amazon3. Gel Keyboard & Mouse Wrist Rest Set
Soft, cool gel pads that sit in front of the keyboard and under the mouse hand.
Why it helps: Cushions the hard desk edge that presses into the wrist. An easy, cheap desk upgrade.
Check price on Amazon3. Stretching and nerve gliding exercises
Gentle exercises help the tendons and median nerve move freely. The nerve runs all the way from the neck to the hand, and tightness higher up (sometimes called the "double crush" effect, like stepping on a garden hose in two places) can add to wrist symptoms. That's why therapists often include the neck and shoulders. A favorite is the "Titanic" stretch, named after the famous pose on the bow of the ship:
- Stand tall with your shoulders relaxed.
- Bring your arms down and slightly behind you, elbows straight, palms facing forward and thumbs pointing out.
- Gently open your chest and draw your arms back until you feel a mild stretch in the front of the shoulders and forearms.
- Slowly tilt your head toward one shoulder and breathe for a few seconds, then return to center and repeat on the other side.
Other simple stretches include gently pulling the fingers and palm back to stretch the wrist, holding for a few seconds. Whatever the exercise, the principles are the same: move gently, hold each stretch for a few seconds, keep the neck relaxed and maintain good posture. Stop if anything makes the tingling worse, and ask a physical or hand therapist for a routine tailored to you.
4. Steroid injections
A small amount of corticosteroid, sometimes with local anesthetic, injected into the carpal tunnel can reduce swelling and relieve symptoms, often for weeks to months. It's frequently a temporary rather than permanent fix, and possible downsides include pain during the injection, infection (rare), temporary rise in blood sugar for people with diabetes, lightening of the skin at the injection site, and, very rarely, damage to tendons or small nerve branches.
5. Surgery (carpal tunnel release)
If symptoms are severe, constant, or not improving with other treatments, surgeons can cut the transverse carpal ligament to give the nerve more room. It's a common, usually quick procedure, often done under local anesthetic as day surgery, either through a small open cut in the palm or with a keyhole (endoscopic) technique.
Most people get good relief, especially from night-time symptoms. As with any operation there are risks, including infection, nerve injury, temporary weakness of grip while the wrist adapts (this usually improves over several months), stiffness, a tender scar, and occasionally symptoms returning. If the nerve was badly compressed before surgery, some numbness or weakness may remain.
After surgery: common advice
- Keep the hand raised for the first couple of days to reduce swelling.
- Keep the fingers moving from the start, as your surgeon advises.
- Keep the wound clean and dry until the stitches are out (often about 10 to 14 days).
- Avoid heavy lifting and forceful gripping for several weeks while strength returns.
- Gently massage the scar once it has healed, and go to all follow-up appointments.
Always follow your own surgeon's instructions, as they vary.
When to see a doctor
See a doctor if tingling or numbness lasts more than a few weeks, keeps waking you up, or comes with weakness, clumsiness or dropping things. Earlier treatment usually means simpler treatment and a better recovery.