What Is Wrong With My Hand?
Do you wake with tingling or numbness in your hand? Have your fingers started feeling clumsy when holding a pen, using your phone, doing up buttons or opening a door?
There are a number of reasons this can happen, but one possibility is carpal tunnel syndrome.
Carpal tunnel syndrome occurs when the median nerve becomes compressed as it travels through a narrow passage at the wrist called the carpal tunnel.
It is one of the most common nerve compression problems affecting the upper limb, but not every tingling hand is carpal tunnel syndrome. Similar symptoms can arise from other nerves, the neck, medical conditions or problems elsewhere along the course of the nerve.
A thorough physiotherapy assessment can help determine whether your symptoms fit the pattern of carpal tunnel syndrome or whether something else needs to be considered.
What Is Carpal Tunnel Syndrome?
The carpal tunnel is a relatively small space at the front of the wrist formed by the wrist bones and a strong band of connective tissue called the transverse carpal ligament.
The median nerve travels through this tunnel alongside several tendons that control the fingers.
If pressure within the tunnel increases, the median nerve can become irritated or compressed. This can affect the sensory information travelling from the hand and, in more significant cases, the nerve's ability to activate certain muscles around the thumb.
What Does Carpal Tunnel Syndrome Feel Like?
The classic symptoms are numbness, tingling, pins and needles or burning sensations affecting the median nerve distribution of the hand.
This commonly includes:
- The thumb.
- The index finger.
- The middle finger.
- The thumb side of the ring finger.
Symptoms are often worse at night and may wake people from sleep. A common feature is feeling the need to shake or flick the hand to settle the tingling.
Symptoms can also appear during activities where the wrist is held in one position for a prolonged period, such as driving, holding a phone or reading.
In more advanced cases, people may notice reduced grip, difficulty with fine motor tasks or weakness around the thumb.
Which Symptoms Are Less Typical of Carpal Tunnel Syndrome?
Not every hand symptom fits neatly with carpal tunnel syndrome.
Some findings that may lead us to consider another source include:
- Symptoms predominantly affecting the little finger, which is supplied by the ulnar nerve rather than the median nerve.
- Numbness over the fleshy base of the thumb or central palm, as this area receives sensation from a branch of the median nerve that travels outside the carpal tunnel.
- Significant neck pain associated with arm or hand symptoms.
- Weakness involving muscles outside the median nerve distribution.
- Symptoms following a traumatic injury.
Carpal tunnel symptoms can sometimes travel into the wrist or forearm, so symptom location alone does not provide the diagnosis.
Why Does Carpal Tunnel Syndrome Happen?
There is not always one obvious cause.
Carpal tunnel syndrome is associated with a number of factors that can increase pressure within the tunnel or make the median nerve more vulnerable to compression.
These can include:
- Pregnancy and fluid retention.
- Diabetes.
- Thyroid disorders.
- Rheumatoid arthritis and some other inflammatory conditions.
- Previous wrist fractures or trauma.
- Higher body weight.
- Some occupational exposures involving repetitive force or vibration.
Sometimes there is no obvious reason at all.
It is also worth separating repetitive hand use from the idea that ordinary computer use automatically causes carpal tunnel syndrome. The relationship between everyday keyboard use and carpal tunnel syndrome is much less straightforward than was once assumed.
How Is Carpal Tunnel Syndrome Diagnosed?
Diagnosis usually begins with your symptoms and a physical examination.
Your physiotherapist may assess:
- The distribution of numbness or tingling.
- Sensation in different parts of the hand.
- Grip and thumb strength.
- Muscle bulk around the thumb.
- Whether certain wrist positions reproduce your symptoms.
- The neck, shoulder, elbow and other nerves if another source is suspected.
No single physical test is perfect, so findings are interpreted together rather than relying on one test alone.
Do I Need a Nerve Conduction Test or Scan?
Not everyone with suspected carpal tunnel syndrome needs imaging or electrical nerve testing.
In many people with a typical clinical presentation, the diagnosis can be made from the history and examination.
Nerve conduction studies and electromyography can be useful when the diagnosis is uncertain, symptoms are more severe, there is significant weakness or sensory loss, or further information about nerve function would influence treatment decisions.
Ultrasound can also provide information about the median nerve in selected cases.
MRI is not routinely required to diagnose straightforward carpal tunnel syndrome.
How Is Carpal Tunnel Syndrome Treated?
Treatment depends on how severe the symptoms are and whether there is evidence of significant loss of nerve function.
For mild to moderate symptoms, treatment will often begin conservatively.
The aim is to reduce aggravating pressure on the median nerve while maintaining normal use and function of the hand where possible.
Can a Wrist Splint Help?
A neutral wrist splint worn at night is one of the simplest conservative treatments for carpal tunnel syndrome.
Many people naturally sleep with their wrist curled forwards or backwards. These positions can increase pressure within the carpal tunnel.
A night splint aims to keep the wrist in a more neutral position while you sleep.
It does not need to completely immobilise the hand during the day, and wearing a splint continuously is not necessarily better.
What About Nerve Gliding Exercises?
You may have seen median nerve or tendon gliding exercises recommended for carpal tunnel syndrome.
These exercises involve specific movements of the fingers, wrist, elbow and sometimes shoulder designed to change the movement and loading of the median nerve and surrounding tissues.
They may be useful for some people as part of a broader management plan, but they are not a way of physically “freeing” a trapped nerve or repairing nerve damage.
They also should not significantly aggravate tingling or numbness.
If exercises are appropriate, your physiotherapist can help determine the type and amount of movement that makes sense for your presentation.
What About Massage, Manual Therapy or Dry Needling?
Hands-on treatment may sometimes help with associated discomfort or movement limitations, but carpal tunnel syndrome is fundamentally a compression neuropathy of the median nerve.
Massage or manual therapy should therefore not be presented as a method of directly reversing the nerve compression.
Treatment should instead focus on the factors that are relevant to the individual, the severity of the symptoms and the function of the hand.
Do Cortisone Injections Help?
Corticosteroid injections into the carpal tunnel can improve symptoms for some people, particularly in the short term.
However, current evidence suggests that they do not provide reliable long-term resolution of carpal tunnel syndrome.
An injection may therefore be considered as one management option rather than automatically being viewed as a permanent fix.
Your GP or specialist can discuss whether this is appropriate for your individual situation.
When Is Surgery Considered?
Carpal tunnel release surgery creates more space for the median nerve by releasing the ligament forming the roof of the carpal tunnel.
Surgery may be considered when:
- Symptoms are severe or persistent.
- There is significant or progressive weakness.
- There is muscle wasting around the base of the thumb.
- Numbness has become constant.
- Testing shows substantial impairment of median nerve function.
- Appropriate conservative treatment has not provided adequate relief.
The decision is not based simply on how many months symptoms have been present. Severity, neurological function, progression and the effect on everyday life all matter.
Can Carpal Tunnel Syndrome Cause Permanent Nerve Damage?
Most people with intermittent or mild carpal tunnel symptoms are not experiencing irreversible nerve damage.
However, longstanding and severe compression can eventually affect sensation and muscle function.
This is why progressive weakness, constant numbness or visible wasting of the muscles around the thumb should not simply be ignored.
Earlier assessment can help determine how significant the problem is and whether conservative treatment remains appropriate.
What Else Can Cause Tingling or Numbness in the Hand?
Carpal tunnel syndrome is only one possibility.
Hand symptoms can also arise from:
- Other peripheral nerve entrapments.
- Irritation of nerves around the elbow.
- Nerve roots within the neck.
- Previous trauma.
- Peripheral neuropathy.
- Some medical and neurological conditions.
This is why treating every tingling hand as carpal tunnel syndrome can lead you in the wrong direction.
When Should I Get My Hand Assessed?
An assessment is worthwhile if you have persistent or recurring:
- Pins and needles in the hand.
- Numbness.
- Night-time symptoms that wake you.
- Weakness or loss of grip.
- Difficulty with buttons, pens or other fine hand movements.
- Symptoms that are gradually becoming more frequent or severe.
More urgent medical assessment is appropriate if there is rapidly developing weakness, sudden significant neurological change, substantial trauma or symptoms involving several areas of the body at once.
So, What Is Wrong With My Hand?
If your hand is tingling, numb or becoming clumsy, carpal tunnel syndrome is certainly one possibility, but it is not the only one.
The pattern of symptoms, examination of sensation and strength, and assessment of the median nerve and surrounding areas can help work out where the symptoms are coming from.
From there, treatment can be matched to the actual problem rather than simply treating the hand because that is where you feel the symptoms.
Our physiotherapists can assess hand and upper-limb symptoms as part of a broader physiotherapy assessment and help determine whether conservative treatment is appropriate or whether further medical investigation is required.
