Carpal Tunnel Syndrome: Symptoms, Causes, and Treatment Options

What Is Carpal Tunnel Syndrome?

The carpal tunnel is a narrow channel on the palm side of the wrist, formed by the wrist bones on three sides and a ligament called the transverse carpal ligament on the fourth. Running through this tunnel is the median nerve — the nerve responsible for sensation in your thumb, index, middle, and part of your ring finger — along with nine tendons that flex the fingers.

Carpal tunnel syndrome (CTS) occurs when pressure builds up inside this tunnel and compresses the median nerve. The compression disrupts nerve signaling, producing the characteristic symptoms of numbness, tingling, and pain in the hand. It is one of the most common nerve compression conditions, affecting an estimated 3 to 6 percent of adults in the general population.

Who Gets It and Why

Carpal tunnel syndrome does not have a single cause. Several factors can increase pressure within the tunnel or make the nerve more susceptible to compression:

Anatomy — Some people have a naturally narrower carpal tunnel, which is partly hereditary. This is why CTS often runs in families.

Repetitive hand use — Activities involving prolonged wrist flexion, extension, or vibration can contribute to swelling and elevated tunnel pressure over time.

Medical conditions — Diabetes, hypothyroidism, rheumatoid arthritis, and pregnancy all increase the risk of CTS, either by affecting nerve health directly or by causing fluid retention and swelling within the tunnel.

Obesity — Higher body mass index is an independent risk factor, likely related to increased soft-tissue pressure around the wrist.

It is worth noting that keyboard use is frequently blamed but is not strongly linked to CTS in research. The relationship between office work and carpal tunnel syndrome is more nuanced than popular belief suggests.

Recognizing the Symptoms

The hallmark symptoms of CTS are numbness and tingling in the thumb, index, and middle fingers. These symptoms are often worse at night or first thing in the morning, because many people sleep with their wrists bent. You may also notice that shaking your hand provides temporary relief — a response known as the "flick sign."

As the condition progresses, symptoms may occur during the day as well, particularly during activities that involve holding a phone, gripping a steering wheel, or reading. In more advanced cases, weakness in the grip and difficulty with fine motor tasks like buttoning clothing can develop. Thenar muscle wasting — visible flattening of the muscle at the base of the thumb — indicates significant and chronic nerve compression.

Treatment: From Conservative to Surgical

Wrist splinting is typically the first step. Wearing a neutral-position splint at night keeps the wrist from flexing and reduces nerve compression during sleep. Many patients experience significant symptom relief from splinting alone.

Corticosteroid injections into the carpal tunnel reduce inflammation and relieve pressure on the nerve. They are effective in the short to medium term and can help confirm the diagnosis while providing relief.

Activity modification — changing the ergonomics of your workstation, taking breaks from repetitive tasks, or modifying grip patterns — may reduce symptom burden in milder cases.

Carpal tunnel release surgery is indicated when symptoms are severe, when nerve conduction studies show significant median nerve dysfunction, or when conservative treatment has failed over several months. The procedure involves cutting the transverse carpal ligament to widen the tunnel and relieve pressure. It is typically done as an outpatient procedure under local anesthesia and has a high success rate. Minimally invasive endoscopic techniques are available and allow for faster return to activity compared to open release.

If you're experiencing numbness, tingling, or weakness in your hand, the specialists at Maryland Orthopedic Specialists can help. Call (301) 515-0900 or [schedule an appointment online](https://www.mdorthospecialists.com/contact).