Carpal Tunnel Syndrome: Numbness and Night Symptoms in the Hand
Compression of the median nerve at the wrist, causing numbness, tingling and night waking.
The carpal tunnel is a narrow passage on the palmar side of the wrist formed by bones and a ligament. The finger flexor tendons and the median nerve run through it. Increased pressure within the tunnel compresses the nerve, producing numbness, tingling and, over time, weakness. It is the most common nerve compression in the hand.
Symptoms
- Numbness and tingling in the thumb, index and middle fingers
- Symptoms that wake you at night, relieved by shaking or hanging the hand down
- Numbness while driving, holding a phone or reading a newspaper
- Dropping objects and clumsiness with fine tasks
- In advanced cases, wasting of the muscle at the base of the thumb
Numbness confined to the ring and little fingers usually indicates a different nerve; the distinction is made on examination.
Risk Factors
- Repetitive hand and wrist movements; use of vibrating tools
- Pregnancy and hormonal changes (often temporary)
- Diabetes, thyroid disorders and inflammatory conditions
- Altered tunnel anatomy after a wrist fracture
- Excess weight
Diagnosis and Treatment
Examination tests whether wrist positions provoke the numbness and assesses thumb muscle strength. Nerve conduction studies (EMG) confirm the diagnosis, grade the compression and exclude other nerve problems.
Non-surgical treatment is the first step: a night splint holding the wrist in neutral, activity modification, review of workplace ergonomics, nerve gliding exercises and, in selected patients, an injection into the tunnel. Surgery is considered when night symptoms persist, when EMG shows significant compression, or when muscle wasting has begun. Through a small incision the roof of the tunnel is released. Results are better when the procedure is performed before wasting develops, so delay should be avoided.
If numbness wakes you at night, if you have started dropping objects, or if you notice thinning at the base of the thumb, seek assessment without delay.
Frequently Asked Questions
Does numbness disappear immediately after surgery?
Night symptoms usually improve markedly at an early stage. In nerves compressed for a long time, full recovery may take months — which is why early presentation matters.
Is a splint enough?
In mild to moderate cases, particularly when symptoms are recent, a night splint can provide considerable relief. It is not sufficient once muscle wasting is present.
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