Carpal tunnel syndrome is one of the most common reasons people are referred to a hand surgeon. The symptoms — numbness, tingling, and night-time hand pain — are familiar enough that most people recognise them in someone they know. The diagnosis and treatment, on the other hand, are widely misunderstood. This guide explains what carpal tunnel syndrome is, how it is diagnosed, what conservative and surgical treatments actually achieve, and what recovery from surgery looks like.

What is carpal tunnel syndrome?

The carpal tunnel is a narrow passage at the front of the wrist. Its floor and walls are formed by the small bones of the wrist; its roof is a tough fibrous band called the . Through this tunnel run nine tendons that bend the fingers, and the , which carries sensation from the thumb, index, middle, and the thumb-side half of the ring finger.
When the tunnel becomes crowded — most often because the lining of the tendons thickens with age or use — the median nerve is squeezed. The squeezed nerve sends abnormal signals: numbness, tingling, sometimes a burning ache. If the compression continues for long enough, the nerve loses function, and weakness in the muscles at the base of the thumb appears.
The condition is common. It affects roughly 4–5% of adults at some point. It is more common in women, in people with diabetes, in pregnancy (where it usually settles after delivery), and in those whose work or hobbies involve sustained gripping or vibration. Genetic factors play a role; many patients describe the same symptoms in a parent or sibling.

How do I know if I have it?

The early symptoms are recognisable:
  • Numbness or tingling in the thumb, index, and middle fingers — often felt across all of them at once.
  • Symptoms that wake you from sleep, particularly in the early hours of the morning. People describe shaking the hand or hanging it over the bed to relieve the tingling.
  • A worsening of symptoms during repetitive activities — driving, holding a phone, reading a book, working at a keyboard.
  • In more advanced cases, dropping objects, weakness when opening a jar, or difficulty with fine pinch.
Your hand specialist will examine the hand for sensation, strength, and any visible wasting of the muscles at the base of the thumb. Two simple tests — the (holding the wrists in a flexed position) and the (tapping over the nerve at the wrist) — provoke symptoms when the median nerve is compressed.
A specific clinical scoring system, the criteria, allows a confident diagnosis in straightforward cases without further investigations. Where the diagnosis is uncertain — for example when symptoms are atypical, or when there may be a problem in the neck or another nerve — further investigation is helpful.
measure how quickly electrical signals travel through the median nerve at the wrist; a slowed signal confirms compression and grades its severity. Nerve conduction studies remain the reference standard when severity grading matters or when the diagnosis needs to be confirmed against alternatives.
of the wrist is a useful and increasingly common alternative. It shows the median nerve directly and measures whether the nerve is enlarged at the level of the carpal tunnel — a structural sign of compression. Ultrasound is quicker, more comfortable for the patient, and more readily accessible than nerve conduction studies; it is well-suited to confirming the diagnosis in straightforward cases. The two investigations are complementary rather than competing: nerve conduction studies measure how the nerve is working, ultrasound shows what the nerve looks like, and either is acceptable for confirming a clinical diagnosis.1

What can I try first?

The right starting point depends on how severe the symptoms are, on what has already been tried, and on the patient's own preferences and tolerance for waiting. Some patients arrive having tried nothing; others have tried several measures, sometimes correctly and sometimes not. Both situations are common, and both deserve honest discussion rather than a single rigid algorithm.
The conservative measures with the best evidence are:
  • Night-time wrist splinting. A simple wrist splint worn at night keeps the wrist in a neutral position, which reduces pressure within the carpal tunnel during sleep. For mild and moderate symptoms, several weeks of consistent night splinting often reduces the night-time waking, and in some cases is enough on its own. It works best when used every night, not just on bad nights.
  • Activity modification. Where a specific activity reliably provokes symptoms, modifying or pacing it helps. This is rarely curative but reduces day-to-day discomfort while other measures take effect.
  • Corticosteroid injection. A single injection of corticosteroid into the carpal tunnel reliably reduces symptoms in the short term, and on average delays the need for surgery — by about a year on placebo-controlled follow-up. It does not, however, provide durable relief: most patients who initially respond have a recurrence of symptoms within months, and the great majority eventually proceed to surgery.2,3 Injection is most useful when there is a defined reason to delay surgery — pregnancy, an upcoming event, a need to confirm the diagnosis — rather than as a long-term solution. Any injection into the carpal tunnel should be performed under ultrasound guidance, which places the medication accurately and avoids inadvertent injury to the median nerve; blind injection is no longer acceptable practice.
Some treatments often promoted online have not held up in good-quality studies. Platelet-rich plasma injections do not provide durable benefit. Ultrasound therapy, laser therapy, and most over-the-counter supplements have minimal effect. The 2024 American Academy of Orthopaedic Surgeons guideline reviews these options in detail.4
If a patient has already tried night splinting consistently for several weeks without benefit, or has already had a corticosteroid injection that helped but wore off, then the conversation reasonably moves on to surgery. If conservative measures have not been tried, or have been tried inconsistently, a structured trial of splinting is often a reasonable first step — provided the symptoms are not severe enough to make further delay unwise.

When is surgery considered?

Surgery is considered when one or more of the following is true:
  • Symptoms persist despite a documented trial of night splinting and activity modification.
  • There is constant numbness, fixed sensory loss, or measurable weakness in the muscles at the base of the thumb.
  • Nerve conduction studies show moderate or severe disease.
  • Acute symptoms develop after a wrist fracture or other trauma — in which case surgery is often urgent rather than elective.
The operation itself — open carpal tunnel release — is short, performed under local anaesthetic in a day-case setting, and divides the transverse carpal ligament so that the nerve is no longer compressed. Long-term symptom relief is durable: revision rates in large series sit at around 5%, and most patients are satisfied at long-term follow-up.5 Recovery is faster than many patients expect — most people sleep through the night within the first week, drive within one to two weeks, and return to office or light work within two to three weeks. Manual work typically takes four to six weeks. Some discomfort at the base of the palm — known as — is common in the months after surgery and usually settles by three to six months.
A separate page describes the operation in detail, including the technique, what to expect on the day, and recovery in full: see Open Carpal Tunnel Release. The choice between open and endoscopic technique is a separate question, decided in consultation, and addressed on a separate page.

What does recovery look like?

After surgery, the hand is bandaged with a soft padded dressing. Finger movement is encouraged from the first day; no wrist splint is used. Stitches are removed at 10 to 14 days. Most patients are referred to a hand therapist for a structured early consultation that covers exercises, swelling management, scar care once the wound is healed, and return-to-work planning.
The relief from night-time tingling and numbness is usually the first thing to improve, often within the first few nights. Day-time numbness in the fingers takes longer to resolve, particularly when the nerve has been compressed for a long time before surgery; in some cases a small amount of numbness may remain permanently. Grip strength returns gradually over three to six months.
The complications of surgery are uncommon but worth understanding before agreeing to the operation: pillar pain (described above), scar tenderness, wound infection (less than 1%), and rarely, persistent or recurrent symptoms. The full list is discussed during consent and is detailed on the procedure page.

What to do next

If the symptoms in this guide match what you are experiencing, the next step is a clinical assessment — by a general practitioner first, who can refer to a hand specialist when appropriate. Bring a clear note of when symptoms started, how often they wake you, and what (if anything) has already been tried. That history shapes the decision about what to do next more than any single test result.