Patient information · Orthopaedics and neurology
Carpal tunnel syndrome
why it wakes you, and what to do about it
Carpal tunnel syndrome is compression of a nerve as it passes through a tight tunnel at the wrist. It causes tingling, numbness and pain in the thumb, index and middle fingers, characteristically waking you in the small hours. It is very treatable, and treating it before the nerve is damaged gives much better results.
Arrange prompt assessment if you have
- constant numbness that no longer comes and goes
- weakness of the hand, dropping things, or difficulty with buttons and keys
- visible wasting of the fleshy pad at the base of the thumb
- symptoms following a wrist fracture or injury, or a sudden onset with severe pain and swelling
- symptoms in both hands alongside neck pain, or spreading beyond the hand
Constant numbness and thumb muscle wasting indicate established nerve damage, which recovers slowly and sometimes incompletely even after successful surgery. This is the point at which waiting stops being harmless.
Why the symptoms are worse at night
Most people sleep with their wrists curled, which narrows the tunnel further, and fluid redistributes when lying flat. The result is the classic story: waking at two or three in the morning with a hand that feels dead or burning, then shaking or hanging it out of bed until it settles. That pattern is close to diagnostic.
During the day, symptoms typically come on when holding a phone, driving, reading a newspaper or using tools — anything sustaining a wrist position.
What causes it
- Often no identifiable cause at all
- Pregnancy, particularly the later months — usually resolves after delivery
- An underactive thyroid, diabetes, rheumatoid arthritis
- Previous wrist fracture, or arthritis at the wrist
- Repetitive forceful gripping and prolonged vibration — the link with ordinary keyboard work is much weaker than commonly assumed
- Being significantly overweight, and the menopause
Treatment, in order
- A night splint holds the wrist straight while you sleep and is the single most useful first step. It needs wearing every night for at least six weeks before judging it. Many people abandon it after three nights because it feels awkward — persistence is what makes it work.
- Activity modification — breaking up sustained gripping, adjusting workstation and tool use, avoiding prolonged wrist flexion.
- A steroid injection into the carpal tunnel often gives good relief. The effect may be temporary, but a good response also helps confirm the diagnosis.
- Nerve conduction studies measure how well the nerve is working. They confirm the diagnosis, grade severity, and are usually required before surgery.
- Surgery — carpal tunnel decompression — is a short procedure under local anaesthetic that releases the ligament over the nerve. It is highly effective, particularly for night symptoms, which often resolve immediately.
What surgery does and does not fix
Night waking and tingling usually improve very quickly. Numbness and weakness that have been present for a long time improve more slowly and may not fully recover, because the nerve fibres themselves have been damaged. This is the practical argument for not putting it off for years. Expect some tenderness in the palm for six to twelve weeks after surgery, and use of the hand for light activities almost immediately.
Self-help while you wait
- Wear the splint every night without exception.
- Take breaks from sustained gripping; alternate tasks rather than pushing through.
- Shake the hand out and change position when symptoms start rather than persevering.
- Nerve gliding exercises may help — ask our physiotherapy team to show you rather than following a video.
- Have thyroid function and glucose checked if this has not been done.
Book an appointment if night symptoms are disturbing your sleep, splinting has not helped after six weeks, you have any numbness that is now constant, or you want nerve conduction studies or to discuss surgery. Our orthopaedic and physiotherapy services are on site, and nerve conduction studies are arranged through our CQC-registered partners.
Orthopaedics, physiotherapy and surgery
Same-day appointments most days, seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.