Carpal Tunnel Syndrome: What It Is and What Helps

Carpal tunnel syndrome is the most common nerve compression condition, and its symptom pattern is distinctive enough to be recognisable.

The anatomy

The carpal tunnel is a narrow passage at the wrist bounded by carpal bones and the transverse carpal ligament. Nine flexor tendons and the median nerve pass through it. Because the space is fixed, anything that increases pressure inside it - tendon sheath swelling, fluid retention, structural change - compresses the median nerve. That compression produces the symptoms, and the nerve is the softest structure in the tunnel.

The classic pattern

Numbness and tingling in the thumb, index, middle and half the ring finger, following median nerve distribution and characteristically sparing the little finger. Symptoms are typically worse at night, often waking people, and people commonly describe shaking the hand for relief. Symptoms may occur when driving or holding a phone. In more advanced cases, weakness of thumb abduction and wasting of the thenar muscles at the base of the thumb develop. The little finger sparing is the useful distinguishing feature.

What the evidence supports

Night splinting holding the wrist neutral has reasonable evidence for mild to moderate cases, because wrist flexion during sleep raises tunnel pressure. Activity modification helps where a clear aggravating activity exists. Corticosteroid injection provides temporary relief in many cases. Surgical release has good outcomes for moderate to severe cases and where conservative measures fail. Where symptoms include persistent numbness or any weakness, medical assessment should not be delayed, since prolonged compression can produce permanent change.

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