Carpal Tunnel Syndrome Treatment
Carpal tunnel syndrome (CTS) is one of the most common causes of hand pain, tingling and numbness. This guide explains what carpal tunnel syndrome is, what causes it, and the treatments available to help relieve symptoms and improve hand function.
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome occurs when the median nerve becomes irritated or compressed as it passes through a narrow passage in the wrist called the carpal tunnel.
This compression is often caused by:
- Swelling of the tendons within the tunnel
- Age-related narrowing or stiffness of the tunnel
- Increased pressure around the nerve
The median nerve provides feeling to the thumb, index, middle and part of the ring finger. When compressed, it can cause:
- Pain or aching in the hand or wrist
- Tingling (“pins and needles”)
- Numbness
- Weakness or reduced grip strength
Symptoms are often worse during the night and may wake you from sleep. Many people find relief by shaking their hand or hanging it over the side of the bed.
Symptoms can also occur during activities such as:
- Typing
- Writing
- DIY
- Housework
- Repetitive hand movements
What Causes Carpal Tunnel Syndrome?
Carpal tunnel syndrome is common and may develop for several reasons, including:
- Repetitive hand or wrist movements
- Frequent keyboard or mouse use
- Jobs requiring prolonged bent wrist positions
- Use of vibrating tools
- Wrist arthritis
- Pregnancy
- Thyroid disorders
Sometimes symptoms may actually originate from irritation of nerves in the neck or elbow, or these conditions may exist alongside carpal tunnel syndrome.
Treatment Options
Many people improve without surgery by reducing irritation to the nerve and following conservative treatments.
1. Wrist Splints
A wrist splint helps keep the wrist in a neutral position.
Night splints are particularly useful because they help prevent the wrist bending during sleep, reducing night-time symptoms.
A support splint may also be worn during activities that trigger symptoms.
Your GP, physiotherapist or hand therapist can advise which splint is most appropriate.
2. Steroid Injection
A corticosteroid injection can reduce inflammation within the carpal tunnel and relieve pressure on the median nerve.
Benefits may include:
- Reduced pain
- Less tingling and numbness
- Improved hand function
Relief may last:
- Several weeks
- Several months
- Occasionally permanently
If arthritis is contributing to symptoms, an injection into the wrist joint may also be considered.
After the injection
Most people notice improvement within two weeks.
Recovery usually continues over approximately 4–6 weeks.
Although steroid injections are considered safe and effective, all injections carry small risks which should be discussed with your clinician.
3. Exercises
Exercises help maintain movement of the wrist, tendons and median nerve.
They are particularly useful alongside splinting or following a steroid injection.
A. Wrist Flexion & Extension
Starting position
- Rest your forearm on a table.
- Allow your hand to hang over the edge.
Exercise
- Lift your wrist up while making a gentle fist.
- Relax and allow your hand to drop.
Repeat: 10 repetitions
B. Passive Wrist Flexion Stretch
Starting position
- Rest your forearm on a table.
- Palm facing down.
- Hand hanging over the edge.
Exercise
- Allow your hand to drop naturally.
- Use your opposite hand to gently increase the stretch.
Hold: 20 seconds
Repeat: 5 times
C. Assisted Wrist Extension Stretch
Exercise
- Hold the fingers of your affected hand.
- Gently pull them backwards until you feel a stretch along the inside of your forearm.
- Keep your elbow straight.
Hold: 20 seconds
Repeat: 5 times
When is Surgery Recommended?
Surgery is not usually recommended for occasional daytime symptoms that do not disturb sleep.
It may be considered when:
- Symptoms have lasted six months or longer
- Symptoms disturb sleep at least 2–3 nights each week
- Daily activities or work are significantly affected
- Splinting and/or steroid injection have not provided sufficient relief
- You and your clinician feel surgery is appropriate
Earlier referral is recommended if you have:
- Constant numbness
- Persistent pins and needles
- Permanent loss of sensation
- Muscle wasting at the base of the thumb
- Frequent night-time symptoms
If the diagnosis is uncertain, your clinician may recommend:
- Nerve conduction studies
- A diagnostic steroid injection
Carpal Tunnel Release Surgery
Carpal tunnel release is one of the most successful hand operations.
The procedure is:
- Performed as a day case
- Usually completed under local anaesthetic
- Typically takes around 30 minutes
The aim is to relieve pressure on the median nerve by releasing the ligament forming the roof of the carpal tunnel.
Possible Risks
As with all surgery, complications can occur, although they are uncommon.
Potential risks include:
- Infection
- Ongoing symptoms
- Incomplete symptom relief
- Temporary weakness
- Wrist instability
- Painful scar or neuroma
- Persistent nerve damage if compression has been present for a prolonged period
Across large published studies, the overall complication rate for carpal tunnel surgery is approximately 2.03%.
When Should You Seek Medical Advice?
You should seek assessment if you experience:
- Persistent tingling or numbness
- Night-time symptoms that regularly disturb sleep
- Weakness or dropping objects
- Muscle wasting at the base of the thumb
- Symptoms that continue despite splinting or self-management
Early assessment can improve outcomes and reduce the risk of permanent nerve damage.
Key Points
- Carpal tunnel syndrome is caused by compression of the median nerve at the wrist.
- Night-time tingling and numbness are common early symptoms.
- Splints, exercises and steroid injections are effective treatments for many people.
- Surgery may be recommended when symptoms are persistent, severe or causing muscle weakness.
- Early treatment offers the best chance of full recovery.
