Waking with a numb hand and shaking it out is the symptom that gives it away.
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Carpal tunnel syndrome is compression of the median nerve as it passes through a narrow tunnel at the wrist. It causes tingling, numbness and pain in the hand, and it is very common — particularly in women, in pregnancy, and in middle age.
The most useful diagnostic feature is what happens at night. Carpal tunnel wakes you in the early hours with a numb, burning, tingling hand — and you shake it or hang it out of the bed and the symptoms ease. That pattern is close to diagnostic, and no other common hand problem behaves that way.
The second is which fingers. The median nerve supplies the thumb, index, middle and half of the ring finger — and spares the little finger. Tingling that includes the little finger is a different nerve and a different problem.
Two things worth knowing:
The tunnel is a fixed space bounded by bone and a tough ligament. Anything that increases the volume inside it — swelling, fluid, thickened tissue — compresses the nerve, because the space cannot expand.
Worth being accurate about, because the popular version is not quite right:
Where work with vibrating tools is involved, that has occupational health implications worth pursuing.
Bilateral symptoms are common and do not suggest anything unusual — though the dominant hand is usually worse and presents first.
Carpal tunnel syndrome is diagnosed largely from the history, which suits a remote consultation well. The night-time pattern and the finger distribution do most of the work.
These confirm the diagnosis and grade its severity. They are not needed in every case — a classic history can be treated on its own merits. They are useful where the picture is unclear, where the neck is a possible source, or before surgery, since most surgeons want them.
We cannot examine your hand. Suspected wasting at the base of the thumb, definite weakness, or persistent numbness needs assessing in person and referring promptly — those findings mean nerve damage rather than nerve irritation, and delay costs recovery.
A wrist splint worn at night stops the wrist bending during sleep, which is what triggers the night symptoms.
Correcting an underactive thyroid can resolve carpal tunnel syndrome entirely. Weight loss helps where relevant. Both are worth pursuing before anything invasive.
A corticosteroid injection into the carpal tunnel is effective, often dramatically so — though the benefit frequently fades over months. Useful for pregnancy, while awaiting surgery, or where symptoms are intermittent. It is a procedure, so we refer.
Carpal tunnel decompression is a short day-case procedure under local anaesthetic, and it is the definitive treatment. Results are generally very good, particularly for night symptoms, which often resolve immediately.
It should not be delayed where there is persistent numbness, weakness or thumb wasting, because nerve recovery becomes less complete the longer compression continues. Tingling recovers well; established wasting may not fully.
Carpal tunnel syndrome is rarely an emergency. Seek urgent assessment for:
Arrange a prompt appointment for:
Book a routine consultation for:
The most useful thing on this page. Check that your splint holds the wrist straight rather than bent forward — look at it side-on with your hand relaxed inside. Many supports sold for wrist pain hold the wrist in slight flexion, which is exactly the position that compresses the nerve.
Wear it at night. Give it four to six weeks. If night waking improves, it is working.
If your job involves vibrating tools or heavy repetitive gripping, this has occupational health implications. Employers have duties to assess and control vibration exposure, and hand-arm problems from vibrating tools are reportable. Raise it formally rather than managing alone — and we can write an occupational health letter setting out the clinical position.
Reassuring: carpal tunnel in pregnancy usually settles within weeks to a few months of delivery. Night splints and patience are almost always the right approach, and it is rarely a reason for surgery. Knowing it is temporary makes a considerable difference to how it feels.
Track two things, since they are what change the plan:
Either means the nerve is under more pressure than splints will fix, and it is time for referral rather than another few months of waiting.
Vitamin B6 supplements, copper bracelets, water tablets and most "carpal tunnel" gadgets sold online. Ergonomic keyboards are comfortable but are not treatment, and the link between typing and carpal tunnel syndrome is much weaker than its reputation suggests.
The cheapest effective treatment for carpal tunnel syndrome costs about ten pounds and is sold in any pharmacy: a wrist splint worn at night. It works because symptoms are driven by wrist flexion during sleep, and keeping the wrist neutral overnight resolves or substantially improves a large proportion of mild to moderate cases.
Most people are never told the splint must be worn at night rather than during the day, which is when it does almost nothing.
Your NHS GP assesses it free, NHS physiotherapy takes self-referral in many areas, and NHS surgery — which is highly effective and usually definitive — is free, though waits vary.
Where a consultation is worth paying for is the assessment behind it, because carpal tunnel is sometimes secondary to something treatable: an underactive thyroid, diabetes, rheumatoid arthritis, or pregnancy. Checking thyroid function and HbA1c is worth doing rather than assuming.
Private steroid injection or nerve conduction studies can shorten a wait, though nerve conduction testing is not needed where the picture is clear.
What should not wait: constant numbness rather than intermittent, or visible wasting of the muscle at the base of the thumb. That indicates nerve damage, and delay risks it becoming permanent — surgery relieves symptoms but does not always restore a wasted muscle.
NICE Clinical Knowledge Summary, Carpal tunnel syndrome, is the principal reference. It recommends a wrist splint worn at night for at least four weeks as first-line for mild to moderate symptoms, with corticosteroid injection as a second-line option.
CKS recommends considering underlying causes — hypothyroidism, diabetes, rheumatoid arthritis, pregnancy and obesity — which is the basis for the testing point above.
CKS advises urgent referral where there is persistent sensory loss or thenar muscle wasting, indicating established nerve compression.
CKS notes nerve conduction studies are not required where the clinical diagnosis is clear, and are reserved for diagnostic uncertainty or pre-surgical assessment.
British Society for Surgery of the Hand guidance covers carpal tunnel decompression, which has high success rates and is the definitive treatment for severe or persistent disease.
Because most people sleep with their wrists bent, which narrows the tunnel, and fluid redistributes when you lie flat. That night pattern — waking in the early hours with a numb hand, and shaking it to relieve it — is the most characteristic feature there is, and it is why a night splint is first-line treatment.
Check the position. The splint must hold your wrist straight, not bent forward — look at it from the side with your hand relaxed. A great many wrist supports sold in shops hold the wrist in slight flexion, which is exactly the position causing the compression. Also give it four to six weeks, and wear it at night rather than during the day.
No — and this is a useful check. The median nerve supplies the thumb, index, middle and half the ring finger, and spares the little finger. Tingling including the little finger points to the ulnar nerve, usually compressed at the elbow, which is a different problem with different treatment.
Probably not, despite the reputation. The evidence linking ordinary keyboard and mouse use to carpal tunnel syndrome is weak. The much stronger occupational associations are vibrating tools and forceful repetitive gripping — drills, grinders, chainsaws, assembly and butchery work. If that is your job, it is worth raising formally.
Almost certainly, yes. Carpal tunnel in pregnancy usually resolves within weeks to a few months of delivery, because it is driven by fluid retention. Night splints and patience are the right approach, and surgery is very rarely needed. Knowing it is temporary genuinely helps.
Not necessarily. A classic history — the right fingers, the night waking, relief on shaking — can be treated on its own. Nerve conduction studies are useful where the picture is unclear, where the neck may be the source, or before surgery, since most surgeons want them.
If symptoms are intermittent tingling, there is no urgency — splints and time are reasonable. But persistent numbness, weakness or wasting at the base of the thumb should not be waited out, because nerve recovery becomes less complete the longer the compression continues. Tingling recovers well after surgery; established muscle wasting may not fully.
No — it is a short day-case procedure under local anaesthetic, and it is curative for most people. Night symptoms often go immediately. You will need a few weeks before heavy gripping, and it is one of the more reliably satisfying operations in this area.
August 23, 2026
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