Carpal Tunnel Syndrome
A squeezed nerve at the wrist causing tingling, numbness and pain in the thumb and first fingers, often waking you at night. Splints and injections help many; surgery usually fixes it for good.
The carpal tunnel ladder
Mild symptoms often respond to steps 1–3. Constant numbness or a weak, wasting thumb means moving up the ladder sooner, before nerve damage becomes permanent.
- Step 1 · Self-careEase off what sets it offCut down on repeated wrist bending, hard gripping and vibrating tools; take regular breaks and keep wrists straight at the keyboard.
- Works
- Helps symptoms settle; no trials in numbers. Carpal tunnel in pregnancy usually goes after the birth
- Cost
- Free
- How long
- Ongoing
- Watch for
- If you work with vibrating tools or repetitive gripping, talk to your workplace about changes.
Your wrists aren’t lazy. They’re overbooked.
- Step 2 · PharmacyNight-time wrist splintA brace that holds the wrist straight while you sleep, so the nerve isn’t squashed by bent wrists.
- Works
- Improves symptoms and hand function within weeks in trials
- Cost
- About $25–50
- How long
- Every night for up to 6 weeks to see if it helps
- Watch for
- It needs to keep the wrist straight, not bent back. A pharmacist or hand therapist can check the fit.
The world’s least glamorous nightwear. Also one of the most useful.
- Step 3 · PrescriptionSteroid injectionA single injection into the wrist to reduce swelling around the nerve.
- Works
- In a UK trial, one injection beat a night splint at 6 weeks and matched it at 6 months
- Cost
- Medicare rebates; out-of-pocket fees vary
- How long
- One injection; relief often lasts months, and symptoms may come back
- Watch for
- Short-lived soreness, skin thinning or paler skin at the site, and raised blood sugar for a few days in diabetes.
Often the quickest relief. Not always the last word.
- Step 4 · SpecialistCarpal tunnel release surgeryA day procedure under local anaesthetic to cut the ligament roofing the tunnel and free the nerve.
- Works
- Better than splinting at 3 months and at a year in trials; usually cures it
- Cost
- Public waiting lists; private fees vary, with Medicare rebates
- How long
- About 20 minutes; around a month to get back to normal activities
- Watch for
- A tender scar and wrist stiffness for a while; infection is less common. Severe, long-standing numbness may not fully recover.
Small cut, big relief, for most. Don’t wait until the thumb muscle has gone.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Vitamin B6Small trials found no clear benefit for symptoms. And too much B6 can itself damage nerves.
- Anti-inflammatory tablets and fluid tablets (diuretics)No better than a dummy pill for carpal tunnel in trials. Fine for short-term pain, but they don’t treat the squeezed nerve.
- Magnets and laser acupunctureNo better than placebo or control in trials.
- Special keyboards and miceTrials give mixed results. Good posture and breaks are free.
What you can do
- Wear a wrist splint at night for up to 6 weeks and keep wrists straight, not curled under your pillow.
- Shake or move your hands when tingling wakes you, then reset the splint.
- Try gentle hand and wrist exercises if they help you; the evidence is limited, but they’re safe.
- Keep a healthy weight and get diabetes or thyroid problems checked and treated; they raise the risk.
- Pregnant? Splints are the main treatment, and symptoms usually settle after the birth.
See your GP if
- Symptoms are getting worse, or not improving after 6 weeks of splinting
- Numbness is constant, rather than coming and going
- You’re dropping things, or your grip or thumb is weak
- The muscle at the base of your thumb looks flatter or thinner
See a doctor the same day for sudden severe numbness or weakness after a wrist injury or fracture. Get urgent help for sudden weakness or numbness of the face, arm or leg, or trouble speaking, which can be a stroke: call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.
Common questions
What are the symptoms?
Tingling, numbness, pain or burning in the thumb, index, middle and half of the ring finger, often worse at night or first thing in the morning. Later, grip can weaken and you may drop things. It can affect both hands.
What causes it?
Swelling in the tight tunnel at the wrist squeezes the median nerve. Risks include pregnancy, being overweight, diabetes, an underactive thyroid, arthritis, wrist injury, repetitive gripping or vibrating tools, and having close family with it. It’s most common in women aged 40–60.
How is it diagnosed?
Usually from your symptoms and an examination of your hand. If it’s unclear or surgery is being considered, a nerve conduction test measures how well the nerve is working, and blood tests may check for diabetes or thyroid problems.
Could it be my neck?
Sometimes. A pinched nerve in the neck can cause similar tingling, usually with neck pain or symptoms further up the arm. Your GP can check.
Helpful resources
- Chartered Society of Physiotherapy: Carpal tunnel exercisesSimple wrist and hand exercises with pictures, to print. Free, UK.
- Healthdirect: Carpal tunnel syndromeSymptoms, causes and treatment, plus the free 24/7 nurse line (1800 022 222). Australia.
Evidence and more information
- NHS: Carpal tunnel syndrome
- NHS: Carpal tunnel syndrome treatment
- Healthdirect: Carpal tunnel syndrome
- Lancet (2018): Steroid injection vs night splint (INSTINCTS trial)
- Cochrane (2008): Surgery vs non-surgical treatment
- Cochrane: Non-surgical treatments other than injection
maladywise.com/carpal-tunnel/