Carpal tunnel syndrome
The hand goes numb at night, you wake up and shake it to bring the feeling back — that is how compression of the median nerve at the wrist usually begins.
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Medicines commonly prescribed for Carpal tunnel syndrome
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 400 mgActive substance: ibuprofenManufacturer: Laboratorios Alter S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Laboratorios Ordesa S.L.Prescription required
The hand goes numb at night, you wake up and shake it to bring the feeling back — that is how compression of the median nerve at the wrist usually begins. It is the commonest nerve entrapment: roughly one adult in twenty develops it at some point. On its own it is rarely dangerous, but it can be an early warning of another illness, and if it is left too long some of what is lost never comes back, even after surgery.
Where the nerve is being squeezed
On the palm side of the wrist there is a narrow passage between the small bones and a thick transverse ligament stretched over them like a belt. Nine flexor tendons and the median nerve run through it into the hand. The walls of that passage are stiff: the bones will not move and the ligament barely stretches. So anything that adds bulk inside — swollen tendon sheaths, fluid, thickened tissue — has nowhere to go, and the softest structure takes the pressure, which is the nerve.
That explains the key feature of the condition: the trouble sits exactly in the territory the median nerve serves, namely the thumb, index and middle fingers and the half of the ring finger nearest the middle one. The little finger gets its sensation from a different nerve and stays out of it. If all five fingers go numb, or the numbness spreads above the elbow, the cause is probably not in the wrist at all but in the neck.
What it feels like
For the first few months the symptoms come and go, which makes them easy to blame on tiredness.
- numbness, tingling and a pins-and-needles feeling in the first three and a half fingers;
- waking at night with a dead hand and needing to hang it over the edge of the bed or shake it until the feeling returns;
- a dull ache running up from the wrist along the forearm, sometimes as far as the elbow and shoulder;
- clumsiness with fine movements: buttons, picking coins off a table and fastening earrings all become harder;
- objects slipping out of the hand — it is less that you drop them and more that you stop feeling you are holding them;
- flattening of the muscle bulge at the base of the thumb, easiest to spot with both hands side by side, palms up.
There is a simple reason the nights are worse. Asleep, nobody minds the position of the hand, the wrist lies bent for hours, and a bent wrist multiplies the pressure inside the tunnel; overnight, fluid also shifts around the tissues. The same mechanism explains why symptoms flare when you hold a phone to your ear, read with the book in your hand or drive for a long stretch.
What actually brings it on
In most people no single cause can be named: the tunnel is narrow by build, and years of hand use add swelling. But several circumstances clearly raise the risk and, more to the point, can be treated.
- pregnancy — symptoms start in the second half and in most women settle within weeks or months of the birth;
- an underactive thyroid, diabetes, excess weight;
- rheumatoid arthritis and other inflammatory joint diseases;
- a previous wrist fracture or dislocation that changed the shape of the tunnel;
- work involving a strong grip and above all vibrating tools: breakers, angle grinders, chainsaws;
- many years on haemodialysis.
Keyboards and mice deserve a straight answer, since the diagnosis is pinned on them almost automatically. There is no convincing evidence that office computer work causes carpal tunnel syndrome. An awkward hand position can make existing symptoms worse, but what creates the disease is force and vibration, not the number of keystrokes.
One cause is worth knowing about separately. An abnormal protein called amyloid is sometimes deposited in the walls of the tunnel. This happens in cardiac amyloidosis, including the inherited form, and in some blood disorders. The striking part is that the hand starts going numb years before any breathlessness, swollen ankles or irregular heartbeat appear. So compression of the nerve in both hands in a man over fifty, particularly alongside breathlessness on exertion, rhythm disturbances or unexplained fatigue, is a reason to look at the heart and not just the hand. The tunnel narrows in a similar way when there is too much growth hormone: the hands, feet and facial features slowly enlarge, and rings and shoes stop fitting.
When waiting is the wrong choice
The numbness has stopped coming in episodes and is now constant. As long as feeling returns between attacks, the nerve is still recovering. Permanent numbness means the damage has become fixed, and from then on time is working against you.
The muscle bulge at the base of the thumb has flattened, the thumb no longer lifts away from the palm and cannot reach the tip of the little finger. That is no longer a symptom but loss of muscle. It recovers slowly and not always fully, so the conversation about surgery should not be put off any further.
After a wrist fracture, a tight dressing or a heavy blow the hand has swollen quickly, the pain is building and the fingers are going numb more and more. This is acute compression: the pressure rises over hours rather than years, and the nerve dies fast. It needs emergency care the same day, not an appointment.
Weakness or numbness came on suddenly, took the whole arm at once, or comes with a drooping face, slurred speech or a weak leg. That picture is not the wrist, it is a stroke, and it is counted in minutes.
In the ordinary way, book an appointment if the symptoms last more than a few weeks, wake you at night, interfere with work, or have appeared in both hands at once.
What you can do yourself
In mild and moderate cases self-help works for a good number of people, but it needs time: judging the result before four to six weeks is premature.
- a night splint holding the wrist straight is the single most effective thing available without a doctor. The straight position is the whole point: models that force the wrist back work less well;
- reviewing the movements that trigger attacks — a sustained hard grip, work with vibration, the habit of sleeping with a bent hand tucked under the cheek;
- breaks during repetitive tasks and support under the forearm so the hand is not left hanging;
- treating the underlying condition: controlling diabetes, correcting an underactive thyroid, losing excess weight — this affects the outcome more than any cream;
- gentle nerve and tendon gliding exercises: the evidence is weak, but they do no harm and sometimes ease the night symptoms.
What not to count on: paracetamol and non-steroidal anti-inflammatory drugs take the edge off the pain but do not relieve the compression and do almost nothing for numbness. Vitamin B6 and diuretics have not proved useful in studies. Heat and rubs give short-lived relief at best.
What the doctor can offer
The diagnosis is usually made from the history and the examination: what matters is the pattern of numbness, the night-time timing, the strength of the thumb and the state of the muscle bulge. Tapping over the wrist and holding the hand bent are tests that get it wrong in both directions, so the decision is not built on them alone. If the picture is atypical, both hands are affected or surgery is on the table, nerve conduction studies are arranged — they show how badly the nerve has suffered — and increasingly an ultrasound scan, which also picks up a lump or thickened sheaths inside the tunnel.
A corticosteroid injection around the tunnel reduces the swelling and clears the symptoms for several months in many people. It is a good way to get through a pregnancy or to bridge the wait for an operation, but it is not a final answer: the symptoms usually return.
The operation divides the transverse ligament so that the tunnel stops pinching. It is done under local anaesthetic, takes about a quarter of an hour and needs no overnight stay. Night-time numbness disappears for most people from the very first night afterwards. What is worth knowing in advance is different: for weeks and sometimes months there is tenderness at the base of the palm either side of the scar and a weaker grip, and that is normal healing. Light activity resumes within a couple of weeks, heavy manual work later. If the nerve has been damaged for a long time and the muscle has already wasted, surgery stops things getting worse but cannot guarantee full return of feeling and strength — one more argument against putting it off.
Online consultation
In an online consultation the doctor goes through which fingers exactly go numb and at what time of day; that is often enough to separate compression at the wrist from a neck problem or a polyneuropathy. They will judge whether there are signs of established nerve damage, in which case a splint alone is not enough, explain how to choose and wear a splint, whether nerve conduction studies and thyroid and glucose tests are needed, and when it makes sense to discuss an injection or an operation.
This material is for information only and does not replace medical advice.
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