In carpal tunnel syndrome, a nerve at the wrist that is responsible for sensation in the thumb, index finger, middle finger, and part of the ring finger is compressed. Typical symptoms include nighttime tingling, numbness, and the hand "falling asleep," which many relieve by shaking it out. The symptoms usually develop slowly over weeks to months. When recognized early, the syndrome can, in many cases, be treated well and without surgery.
Possible causes
Compression of the nerve
In the narrow carpal tunnel at the wrist, the nerve becomes compressed, for example due to swelling or strain. This leads to tingling and numbness in the affected fingers, initially mainly at night.
Strain and overuse
Repetitive hand movements at work or during hobbies can increase the pressure in the carpal tunnel. Modifying the strain often brings relief.
Fluid retention and hormonal influences
During pregnancy or in certain metabolic conditions, increased fluid retention can compress the nerve. Such symptoms often improve again when the situation changes.
Typical steps at the doctor's office
- 1The doctor will ask about the typical pattern — nocturnal tingling, affected fingers, improvement with shaking out — and will test the sensation and strength of your hand with targeted examinations. This often provides a clear picture.
- 2To confirm the diagnosis and assess the severity, a nerve conduction velocity measurement may be performed. It shows how severely the nerve is compressed.
- 3In milder forms, a night-time wrist splint and adjustment of activity levels are the main focus; if needed, a corticosteroid injection can relieve pressure on the nerve. In pronounced or persistent symptoms with loss of strength, a small decompression procedure is the most effective treatment.
What you can do yourself
- A wrist splint worn at night keeps the wrist in a neutral position and relieves nocturnal tingling in many people.
- Take regular breaks during strenuous hand activities and vary your movements.
- Avoid keeping your wrist constantly bent, for example when working with a keyboard and mouse, and set up your workstation ergonomically.
- Gentle stretching and mobilization exercises for the hand and wrist may relieve symptoms.
A doctor's visit is advisable if the nocturnal tingling recurs regularly, if numbness occurs during the day, or if the symptoms interfere with your daily activities. Since early treatment protects the nerve, you should not delay if you experience increasing numbness or weakening hand strength.
Frequently asked questions
- Does this always require surgery?
- No. In milder cases, a nighttime splint and modification of strain are often sufficient. A surgical procedure is only considered for severe, persistent symptoms or when hand strength is declining.
- Why are the symptoms worst at night?
- During sleep, the wrist is often unconsciously bent, which increases the pressure on the nerve. That is why the tingling is typically most pronounced at night, and a splint that keeps the wrist straight helps many people.
- Which doctor should I see?
- Your general practitioner can assess the symptoms well. For detailed evaluation and treatment, neurology, which measures nerve function, and orthopedics are the appropriate specialties.
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