Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome. The median nerve becomes compressed within the carpal tunnel at the wrist, leading to tingling, numbness and pain in the hand. Women are affected more often than men.

Symptoms

  • Tingling and numbness in the thumb, index, middle and ring finger (one side)
  • Hands “falling asleep” at night (a typical early symptom)
  • Pain that can radiate from the wrist into the forearm
  • Relief by shaking the hands (flick sign)
  • In advanced stages: weakness of the thenar muscles, difficulty gripping small objects
  • Muscle wasting (atrophy) of the thenar eminence in long-standing cases

Causes

  • Overuse from repetitive hand movements (computer work, manual trades)
  • Hormonal changes (pregnancy, menopause, hypothyroidism)
  • Diabetes mellitus
  • Rheumatoid arthritis
  • Wrist fractures or injuries
  • Anatomically narrow carpal tunnel
  • Idiopathic (no identifiable cause)

Diagnostics

  • Neurological examination – sensation testing, strength testing of the thenar muscles
  • Provocation tests – Phalen test (flexion of the wrist), Hoffmann-Tinel sign (tapping over the carpal tunnel)
  • Nerve conduction velocity (electroneurography/NCV) – measurement of the conduction velocity of the median nerve at the wrist. A slowing confirms the diagnosis and indicates the severity
  • Nerve ultrasound – ultrasound of the median nerve to visualize nerve swelling within the carpal tunnel
  • EMG (electromyography) – in advanced stages to assess muscle damage

Treatment

Conservative therapy

  • Night splint (wrist in neutral position)
  • Avoidance of triggering strain
  • Cortisone injection into the carpal tunnel (temporary improvement)
  • Treatment of the underlying condition (diabetes, thyroid)

Surgical therapy

  • For persistent symptoms or demonstrated nerve damage: surgical release of the carpal tunnel (referral to hand surgery)
  • The procedure is usually performed on an outpatient basis and generally leads to rapid improvement

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Last updated: 2026-07-04