Carpal tunnel syndrome (neurology)

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What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) is the name for the condition in which the median nerve gets trapped in the carpal tunnel at the wrist. This causes pain, numbness and weakness in the hand. The median nerve is a nerve of the arm which originates from a plexus of nerves near the neck called the brachial plexus. It travels down the arm to reach the carpal tunnel, which it then travels through. The most common site of compression is at the carpal tunnel. The carpal tunnel is a compartment surrounded by hand bones through which the median nerve and many of the tendons of the hand run through. If the tunnel becomes smaller or tighter from any cause, the median nerve may be compressed.

Who to refer, who not to refer, how to refer

Causes of Carpal Tunnel Syndrome

In most cases of Carpal Tunnel there is no obvious identifiable cause. Women are approximately 3 times more likely to develop the condition than men. This can be due to carpal tunnel size. However, the most common causes of carpal tunnel syndrome are:

  • Fluid retention (often seen in pregnancy)
  • Injuries to the wrist
  • Arthritis, some repetitive activities using the hands
  • Obesity
  • Diabetes

Symptoms of Carpal Tunnel

Symptoms can be very mild or disabling. A change in sensation is usually the first symptom which may consist of numbness, burning/tingling or pain. This is commonly felt over the thumb, index and third fingers. In many cases, there may be discomfort of the whole hand and sometimes further up the arm.  Patients often wake at night with these symptoms. In severe cases, hand weakness may develop, particularly in the thumb, with shrinking of the thumb muscles (thenar eminence).

Investigations

Mild sensory symptoms, especially if associated with pregnancy, do not necessarily need any tests. Some patients may need electrical tests to confirm the diagnosis, especially if any treatment is planned.

Treatment

In many cases, symptoms will subside on their own, especially when there is an obvious remediable cause. If treatment is required, stretching exercises and a wrist brace to keep the wrist straight at night over a period of several months would usually be tried first. With more severe symptoms, steroid injections or surgery may be needed.

Referrals should be completed via SCI Gateway

Primary care management

In many cases, symptoms will subside on their own, especially when there is an obvious remediable cause. If treatment is required; stretching exercises and a wrist brace to keep the wrist straight at night for several months would usually be tried first. When there are more severe symptoms, steroid injections or surgery may be needed.

If median distribution sensory symptoms are accompanied by median innervated muscle weakness and wasting, referral should be made to the Orthopaedic Surgeons.

Editorial Information

Last reviewed: 13/03/2025

Next review date: 13/03/2027

Author(s): Dr David Simpson.