The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Hand & Wrist

Carpal Tunnel Syndrome

Carpal tunnel syndrome is one of the most common nerve conditions in the United States, affecting an estimated 3–5% of the general adult population and up to 10% of individuals over a lifetime. The good news: it is also highly treatable, with a range of options from simple night splinting to outpatient surgery that reliably resolves symptoms in the vast majority of patients. At Maryland Orthopedic Specialists, our fellowship-trained hand surgeons diagnose and treat carpal tunnel syndrome every day, offering you expert, individualized care from first evaluation through full recovery.

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What is carpal tunnel syndrome?

Anatomy The carpal tunnel is a narrow, rigid passageway on the palm side of the wrist, roughly the width of a thumb. Its floor and walls are formed by eight small carpal bones arranged in an arch, and its roof is a thick band of connective tissue called the transverse carpal ligament (flexor retinaculum).

Anatomy

The carpal tunnel is a narrow, rigid passageway on the palm side of the wrist, roughly the width of a thumb. Its floor and walls are formed by eight small carpal bones arranged in an arch, and its roof is a thick band of connective tissue called the transverse carpal ligament (flexor retinaculum). Passing through this confined space are:

  • The median nerve — a mixed sensory and motor nerve that supplies sensation to the thumb, index finger, middle finger, and the radial (thumb) half of the ring finger, and provides motor innervation to the thenar muscles at the base of the thumb.
  • Nine flexor tendons — the four flexor digitorum superficialis tendons, four flexor digitorum profundus tendons, and the flexor pollicis longus tendon — each surrounded by a protective synovial sheath.

Carpal tunnel syndrome (CTS) occurs when pressure within the tunnel rises high enough to compress the median nerve, impairing both its sensory and motor functions.

Causes and Risk Factors

No single cause accounts for all cases. CTS most often results from a combination of factors that reduce the space available to the median nerve or increase the volume of structures within the tunnel:

  • Repetitive motion and occupational exposure: Prolonged or forceful wrist flexion/extension, use of vibrating tools, and assembly-line work increase intraneural pressure.
  • Anatomic factors: A congenitally smaller carpal tunnel, wrist fractures (especially distal radius fractures with malunion), and cysts or lipomas within the tunnel.
  • Hormonal and systemic conditions: Pregnancy (fluid retention increases tunnel pressure), hypothyroidism, diabetes mellitus, acromegaly, and obesity are all independently associated with CTS.
  • Inflammatory conditions: Rheumatoid arthritis causes synovitis of the flexor tendon sheaths, reducing tunnel volume.
  • Sex and age: CTS is approximately three times more common in women than men and peaks in the fifth and sixth decades of life.

Epidemiology

CTS is the most common peripheral nerve entrapment syndrome, with an incidence of 1–3 new cases per 1,000 persons per year and a prevalence of roughly 50 cases per 1,000 persons in the general population (Medscape Reference). Clinically confirmed prevalence in the general population has been reported at approximately 3.8% (JAMA). Across a lifetime, about 10% of people will develop the condition (The Lancet).

Treatment options

Non-Operative Treatment

A wrist splint worn at night reduces pressure on the nerve and relieves hand numbness. Avoiding postures that bend the wrist for long periods also helps. A corticosteroid injection into the carpal tunnel provides meaningful relief for months and is often the most effective non-surgical step.

Surgical Procedure

Carpal Tunnel Release

Surgical release of the transverse carpal ligament to decompress the median nerve in the carpal tunnel, eliminating numbness, tingling, and weakness in the hand. Performed open or endoscopically based on patient anatomy.

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Frequently Asked Questions

Q: Do I need surgery for carpal tunnel syndrome?
Not necessarily. Mild to moderate CTS is appropriately managed first with night splinting, activity modification, and/or a corticosteroid injection. Surgery is recommended when non-operative treatment fails to provide adequate lasting relief, when symptoms are severe, when there is evidence of muscle wasting (thenar atrophy), or when electrodiagnostic studies show severe nerve damage. Your MOS hand surgeon will help you decide based on your specific findings and goals.
Q: Will my symptoms come back after surgery?
Recurrence after carpal tunnel release is uncommon. Long-term studies show the majority of patients remain symptom-free for a decade or more after surgery. A small percentage (approximately 1–3%) develop recurrent or residual symptoms from scar formation or incomplete ligament release, which can be addressed with revision release.
Q: What is the difference between open and endoscopic carpal tunnel release?
Both procedures divide the transverse carpal ligament and are equally effective long-term. The primary difference is approach: open release uses a small palm incision for direct visualization; endoscopic release uses a tiny wrist portal and camera to release the ligament from inside. Endoscopic surgery generally results in less postoperative scar tenderness and faster return to full activity, making it preferable for many working patients. Open release remains an excellent, gold-standard option — particularly when anatomy is complex.
Q: Can I wait too long to treat carpal tunnel syndrome?
Yes. Prolonged, severe compression damages the myelin sheath and axons of the median nerve. Once thenar muscles have atrophied, motor recovery is often incomplete even after successful release. Persistent numbness lasting more than 1 year before surgery is associated with slower and less complete sensory recovery. If symptoms are progressive, waking you nightly, or causing weakness, prompt evaluation is important.
Q: Is carpal tunnel syndrome caused by typing or computer use?
This is a common question. While typing and computer use do involve repetitive wrist motion, large epidemiological studies have not found keyboard use alone to be a primary cause of CTS. More relevant risk factors include sustained forceful wrist flexion, use of vibrating tools, and systemic conditions such as diabetes, hypothyroidism, and pregnancy. That said, workstation ergonomics — keyboard position, mouse use, and wrist posture — can aggravate existing CTS, and modification is a standard component of non-operative management.

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Peter G. Fitzgibbons, MD

Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Medically reviewed by Peter G. Fitzgibbons, MD, MD
Last reviewed June 16, 2026

References

  1. Gerritsen AAM, de Vet HCW, Scholten RJPM, et al. "Splinting vs surgery in the treatment of carpal tunnel syndrome: a randomized controlled trial." JAMA. 2002;288(10):1245–1251. doi:10.1001/jama.288.10.1245. https://jamanetwork.com/journals/jama/fullarticle/195279
  2. Bland JDP. "Outcomes of open carpal tunnel release at a minimum of ten years." Journal of Bone and Joint Surgery Am. 2013;95(12):1067–1073. doi:10.2106/JBJS.L.00903. https://pubmed.ncbi.nlm.nih.gov/23783202/
  3. Vasiliadis HS, Nikolakopoulou A, Shrier I, et al. "Endoscopic and open release similarly safe for the treatment of carpal tunnel syndrome: A systematic review and meta-analysis." PLOS ONE / PMC Review. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6942107/
  4. Ashworth NL, et al. "Local corticosteroid injection versus placebo for carpal tunnel syndrome." Cochrane Database of Systematic Reviews (summarized in AAFP / OBGProject). 2023. https://www.obgproject.com/2023/03/23/cochrane-review-do-localized-corticosteroid-injections-improve-carpal-tunnel-symptoms/
  5. Atroshi I, Larsson GU, Ornstein E, et al. "Outcomes of endoscopic surgery compared with open surgery for carpal tunnel syndrome among employed patients: a randomized controlled trial." BMJ. 2006;332:1473. https://pmc.ncbi.nlm.nih.gov/articles/PMC1482334/
  6. O'Connor D, Marshall S, Massy-Westropp N. "Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome." Summarized in: Treatment of carpal tunnel syndrome with wrist splinting — RCT. BMC Musculoskeletal Disorders. 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6712840/
  7. Bland JDP, Ashworth NL. "Single corticosteroid injection vs night splinting: head-to-head RCT." The Lancet. 2018. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31572-1/fulltext31572-1/fulltext)
  8. AAOS OrthoInfo. "Carpal Tunnel Syndrome." American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/carpal-tunnel-syndrome