Treatment for Carpal Tunnel Syndrome
Recognising the Symptoms of Carpal Tunnel Syndrome
Published 15th October 2025
Review date 15th October 2028
Author: Ali Phillips - Consultant Hand Surgeon
What is Carpal Tunnel Syndrome?
Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs through a narrow passageway in your wrist called the carpal tunnel, becomes compressed. Imagine this tunnel has a busy two-way road running through it (the Median nerve). When the tunnel gets crowded due to swelling or other factors, it’s like a traffic jam – the nerve gets squeezed, leading to problems like numbness, tingling, and pain in your hand.
This nerve takes the feeling from your thumb, index, middle, and part of the ring finger (the thumb side of the finger) to the brain and the brain in turn, controls the muscles at the base of the thumb. When it’s compressed, it can’t do its job properly, resulting in the uncomfortable symptoms associated with carpal tunnel syndrome. Some describe it like having a tourniquet on the nerve!
How to prevent Carpal Tunnel Syndrome
While we can’t always prevent carpal tunnel syndrome, there are things you can do to lower your risk:
Ali Phillips | Hand & Wrist Specialist
My hand wakes me up at night!
I'm Ali Phillips. I understand that dealing with pain, numbness, or weakness in your hand can be worrying and disruptive. My goal is to give you clear, kind, and trustworthy information to help you understand what's happening and how we can work together to fix it.
Book a ConsultationWhat is Carpal Tunnel Syndrome?
Imagine a narrow tunnel inside your wrist, called the carpal tunnel. A very important nerve, the median nerve, passes through this tunnel along with the tendons that bend your fingers. Carpal Tunnel Syndrome (CTS) happens when this tunnel gets crowded and the nerve becomes pressed or squeezed. It's like a traffic jam—the nerve can't work properly, leading to the symptoms you feel.
There often isn’t one single cause. Some people have a naturally smaller tunnel, while other factors can include hormonal changes (like pregnancy), medical conditions such as diabetes or thyroid problems, and occasionally, repetitive hand movements.
What are the symptoms of Carpal Tunnel Syndrome?
Tingling & Numbness
A pins-and-needles feeling, especially in the thumb, index, middle, and half of the ring finger.
Nighttime Symptoms
Pain and numbness are often worse at night and can frequently wake you from sleep, with an urge to shake your hand for relief.
Weakness or Clumsiness
You might notice weakness when trying to grip objects or find yourself dropping things more often.
Ready to Sleep Through the Night?
If these symptoms are disrupting your life, you don't have to put up with them. An accurate diagnosis is the first step towards relief. Let's talk about your options.
Find Out Your OptionsDoes this sound like you?
Sarah's Story: The Teacher
Let me tell you about Sarah, a 48-year-old teacher who came to see me. The numbness in her hands was so bad it was waking her up five or six times a night, and she was struggling to hold a pen to mark her students’ work. She was worried about taking a long time off school for recovery. We decided that ultrasound-guided carpal tunnel release was a great option for her. The procedure took about 15 minutes, she went home the same day with just a small plaster on her wrist, and she was back to normal activities within a week. She told me she was finally sleeping through the night again immediately after the procedure. (This is a representative story; details have been changed to protect patient privacy).
David's Story: The Carpenter
David, a carpenter in his fifties, noticed a growing clumsiness in his dominant hand. He was dropping tools and found that the constant vibration from his sander made the tingling in his fingers unbearable by the end of the day. The feeling of weakness in his thumb grip was particularly concerning, as it affected the precision his job required. After trying night splints with only partial success, we discussed his options. He opted for the minimally-invasive surgery, hoping for a quick return to work. The surgery successfully relieved the pressure on the nerve, and with guided hand therapy, he was able to regain his grip strength and return to his workshop, free from the constant, distracting numbness.
How do I know if I have Carpal Tunnel?
When you see me, I'll start by listening carefully to your story and examining your hand. In most cases, the diagnosis is clear from this conversation. One of the tests we can use is Phalen's Test. You can try a modified version gently at home, but please stop if it causes significant discomfort.
1️⃣
Place the backs of your hands together.
2️⃣
Let your fingers point down towards the floor.
3️⃣
Hold this gentle stretch for up to 60 seconds.
If this simple manoeuvre reproduces your tingling or numbness, it might suggest Carpal Tunnel Syndrome. However, an accurate diagnosis from a specialist is the most important first step to getting you on the road to recovery.
Did the test cause tingling?
If you experienced your usual symptoms during the test, it's a strong indicator that you should seek a professional opinion. Don't wait for it to get worse. Let's create a plan together.
Book Your AppointmentHow can I help you get better?
We'll create a treatment plan together, always starting with the simplest, least invasive options first.
Activity Modification We'll figure out what movements trigger your symptoms and find alternative ways to do things to reduce strain.
Wrist Splinting Wearing a splint, especially at night, keeps your wrist in a neutral position to take pressure off the nerve while you sleep.
Hand Therapy A hand therapist can teach you special 'nerve gliding' exercises designed to help the median nerve move more freely within the carpal tunnel.
Medications Simple over-the-counter pain relievers like paracetamol or ibuprofen can help manage pain and inflammation in the short term.
Corticosteroid Injections For more persistent symptoms, an injection of strong anti-inflammatory medicine directly into the carpal tunnel can reduce swelling and provide significant, though often temporary, relief.
If other treatments haven't helped, or if you have constant symptoms or any weakness in your thumb, surgery is often the most effective way to get lasting relief.
What does the surgery involve?
Carpal tunnel release is a quick, safe, and effective procedure. The goal is to cut the tight ligament (transverse carpal ligament) that's pressing on your nerve. I specialise in a modern, minimally invasive technique called Ultrasound-Guided Carpal Tunnel Release. Using an ultrasound scanner to see inside your wrist, I make a tiny incision (just a few millimetres) and use a special instrument to release the ligament, freeing the nerve without disturbing the palm.
Benefits
- Lasting relief from pain and numbness
- Improved hand strength and function
- Prevents permanent nerve damage
- Much faster recovery than traditional surgery
Small Risks
- Infection (risk is about 1 in 200)
- Temporary scar discomfort
- Nerve damage (very rare, about 1 in 2000)
- Need for re-operation (very rare, about 1 in 1250)
The decision to have surgery is one we make together. I will ensure all your questions are answered so you feel confident in our plan.
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always continue with non-surgical treatments like splinting and activity changes, or decide on no active treatment at this time. The decision is always yours and will be respected.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
While carpal tunnel release is a very safe procedure, I want you to be fully aware of the potential issues. The overall complication rate is very low. Potential issues include:
- Persistent Symptoms: While surgery is usually successful, some individuals may not experience complete relief, or full sensation and power may never quite return to normal, especially in severe cases.
- Nerve Irritation or Injury: There is a rare risk of injury to the median nerve or its small branches, which could lead to ongoing numbness or pain. The risk of complications resulting directly from surgery is very rare, about 1 in 2000 cases.
- Scar Tenderness or Pillar Pain: It's common for the incision area to be tender or for you to feel pain in the fleshy part of the palm (pillar pain) after surgery. This almost always improves over time.
- Infection: The risk of a surgical site infection is uncommon for this type of minor surgery, at about 1 in 200 cases.
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Frequently Asked Questions
In very mild cases or if it's caused by something temporary like pregnancy, it can sometimes improve. However, if symptoms are persistent and affecting your sleep or daily life, it's best to seek treatment, as ignoring it can lead to permanent nerve damage in severe cases.
No. The key difference is the type of symptom. Carpal tunnel syndrome causes numbness, tingling, and nerve-type pain. Arthritis typically causes a deep joint ache, stiffness, and swelling directly in the joints. A specialist can help tell the difference.
Surgery is usually recommended when non-surgical treatments haven't worked, if your symptoms are severe and constant, or if you have any weakness in your thumb muscles. This is to prevent long-term nerve damage.
It's a modern, minimally invasive way to do the surgery. Instead of a larger cut in the palm, I use an ultrasound scanner to see inside your wrist and use a tiny instrument to cut the tight ligament through a very small incision of just a few millimetres. This frees the nerve without disturbing the sensitive palm tissue, leading to a much quicker recovery.
Recovery is very fast. You will leave with a small plaster on your wrist and can start using your hand for light activities like dressing and eating right away. Most people are back to driving and normal daily tasks within a few days to a week.
Yes. The procedure is performed under local anaesthetic. This means your hand and wrist will be completely numb, but you will be awake and comfortable. This is much safer than a general anaesthetic.
Fluid retention is very common during pregnancy, and this extra fluid can increase the pressure inside the carpal tunnel, squeezing the nerve. The good news is that for most women, these symptoms go away on their own after the baby is born.
Yes, it is very common to have carpal tunnel syndrome in both hands, although one hand is often worse than the other.
Test Your Knowledge!
FAQ
Carpal tunnel release surgery is typically a quick procedure, often completed within 15-20 minutes. However, the entire process, including preparation and recovery time, might take a bit longer. I even do these in the outpatients so it’s more like going to the optician than for an operation!
The cost can vary based on several factors, such as the surgical technique used, and hospital charges. It’s best to contact my secretary directly on 07368 860628 for a personalised quote and to discuss potential insurance coverage or self-pay options.
Surgery is usually considered when other treatments like splints, medications, or injections haven’t provided enough relief after a few months. It’s also an option if you’re experiencing permanent symptoms throughout the day, severe pain, significant hand weakness, or if nerve tests show significant nerve compression.
If your numbness, tingling, or pain gets worse, even when you’re resting, it could be a sign that your carpal tunnel syndrome is progressing. Also, if you’re having trouble gripping objects or doing daily tasks, it’s important to let me know so we can discuss further treatment options.
The key to a quick recovery is following your post-surgery instructions diligently. This includes proper wound care, doing the recommended hand exercises, and avoiding any heavy lifting or strenuous activities until your wrist has fully healed.
It’s important to keep your wrist elevated and avoid bending it too much while sleeping. The pain from before the surgery will almost certainly be gone on the first night! It can be uncomfortable from the procedure though.
If left untreated, carpal tunnel syndrome can lead to permanent nerve damage and muscle weakness in your hand. In particular, your thumb will become very weak. You might experience persistent numbness, tingling, and pain, and have difficulty performing even simple tasks.
After the ultrasound-guided surgery I use, most people can resume driving within a few days after surgery. However, it’s crucial to follow my specific recommendations and avoid driving until you feel comfortable and confident. Ultimately, you are behind the wheel not me!
Neck problems (cervical radiculopathy) and another nerve issue in the forearm (pronator teres or lacertus syndrome) can sometimes cause symptoms similar to carpal tunnel syndrome. That’s why it’s important to see me for a proper diagnosis.
Carpal tunnel syndrome is common during pregnancy but usually resolves after childbirth. In the meantime, wearing a wrist splint (especially at night), elevating your hands, avoiding aggravating activities, and applying ice can help manage discomfort. Steroid injections are safe for carpal tunnel during pregnancy.
Physiotherapy can be very beneficial for hand and wrist pain. A hand therapist can teach you exercises to strengthen and improve flexibility in your wrists and hands, show you how to perform daily activities without straining your wrists, and help you regain function after surgery. I work with excellent Hand therapists and can recommend them to you when I see you.
In severe cases where carpal tunnel syndrome significantly impacts your ability to perform daily activities or work, it might be considered a disability. If you’re experiencing such limitations, it’s advisable to speak to your GP or a legal advisor about potential benefits or accommodations.
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