top of page

Summary

Carpal tunnel syndrome is pressure on the median nerve at the wrist. It causes numbness, tingling and pain in the thumb, index and middle fingers, often worse at night. Mild cases often settle with a night splint or a steroid injection. When symptoms persist or the nerve is under strain, carpal tunnel release is a short day-case operation under local anaesthetic, and NHS figures show 75 to 92 in 100 people feel better a year later.

​

Written and reviewed by Mr Dafydd (Taff) Edwards FRCS(Tr&Ortho), Consultant Hand, Wrist and Elbow Surgeon, Cleveland Clinic London. Last reviewed: 30 October 2026.

 

Private consultations at Cleveland Clinic London, 55 Moorgate, EC2R 6BH. Call 020 3423 7183 or book online.

What is carpal tunnel syndrome?

The carpal tunnel is a narrow passage at the base of the palm, formed by the wrist bones and a tough ligament. The median nerve and nine tendons run through it. When the space tightens or the tissues swell, the nerve is squeezed, and that causes the symptoms.

It is one of the commonest conditions I see in clinic, and it responds well to treatment.

What are the symptoms?

  • Numbness, tingling or "pins and needles" in the thumb, index, middle and half of the ring finger

  • Pain in the wrist, palm or forearm

  • Symptoms that wake you at night or are worse first thing in the morning

  • Shaking or rubbing the hand to bring the feeling back

  • A weak grip, clumsiness, or dropping things

  • In long-standing cases, wasting of the muscle at the base of the thumb

The little finger is not affected. Tingling in the little finger points to a different nerve, such as cubital tunnel syndrome.

What causes it?

In most people no single cause is found. Factors that raise the risk include:

  • Age over 40 and female sex

  • Pregnancy

  • Diabetes, an underactive thyroid, or inflammatory arthritis

  • A previous wrist fracture

  • Repetitive gripping, or work with vibrating tools

  • Being overweight

If you have carpal tunnel syndrome without an obvious cause, I may suggest a blood test for diabetes and thyroid function, in line with national guidance.

How is it diagnosed?

In most cases the diagnosis is made in clinic from your symptoms and an examination. I test the feeling in each finger, the strength of the thumb muscles, and simple provocation tests such as tapping over the nerve or bending the wrist. You may also complete a short questionnaire (the Boston Carpal Tunnel Questionnaire) that measures how severe your symptoms are.

Do I need a nerve test?

Not always. National guidance recommends nerve conduction studies when the picture is unclear, for example:

  • Symptoms that are atypical or could come from the neck or another nerve

  • Diabetes or a wider nerve problem (neuropathy)

  • Symptoms that persist or return after treatment, including after surgery

  • Work with vibrating tools

  • Possible cubital tunnel syndrome at the same time

A normal nerve test does not rule out carpal tunnel syndrome. I explain why in Normal nerve conduction test and carpal tunnel.

When is it urgent?

Seek same-day assessment if numbness comes on suddenly after a wrist injury or fracture. This is acute carpal tunnel syndrome and can need emergency surgery. Constant numbness, or wasting of the thumb muscles, also needs prompt review, because long-standing pressure can cause permanent nerve damage.

What are the treatment options?

The right treatment depends on how severe your symptoms are and how long you have had them.

  • Night splint. A wrist splint worn at night keeps the wrist straight and takes pressure off the nerve. It suits mild symptoms and pregnancy.

  • Steroid injection. An injection into the carpal tunnel reduces swelling. It often gives relief for months, though symptoms can return. It also helps confirm the diagnosis.

  • Hand therapy. Tendon and nerve gliding exercises and activity advice, often alongside a splint.

  • Carpal tunnel release surgery. Recommended when symptoms are severe, constant, or have not improved after about 12 weeks of other treatment.

Anti-inflammatory tablets and water tablets (diuretics) have not been shown to help carpal tunnel syndrome.

How many people improve? NHS England figures, out of 100 people, one year after treatment:

​

• No treatment (at 6 months): 34 feel better, 66 do not

• Wrist splint: 72 feel better, 28 do not

• Steroid injection: 70 feel better, 30 do not

• Surgery: 75 to 92 feel better, 8 to 25 do not

​

What does surgery involve?

Carpal tunnel release is a day-case operation, usually under local anaesthetic with you awake. A small cut at the base of the palm lets me divide the tight ligament roof of the tunnel, which frees the nerve. The skin is closed with fine stitches and a soft dressing is applied. Most people go home within an hour or two.

​​

How long is recovery?

• Bulky dressing off: 2 to 3 days

• Wound healed, stitches out or dissolved: 2 weeks

• Driving: 1 to 2 weeks, once you can grip the wheel

• Desk work: 1 to 2 weeks

• Light manual work: 2 to 4 weeks

• Heavy manual work: 4 to 8 weeks

• Scar tenderness and grip strength settle: about 3 months

What are the risks?

Serious complications are uncommon. NHS England figures per 1,000 operations:

  • Infection: 3 to 7

  • Permanent nerve damage: 2

  • A second operation needed: 30

Scar tenderness and aching at the base of the palm (pillar pain) are common in the first weeks and usually settle by 3 months.

When should I see a hand surgeon?

  • Symptoms that wake you most nights, or have lasted more than 3 months

  • Numbness that is there all the time

  • Weakness, clumsiness, or wasting at the base of the thumb

  • Symptoms that came back after an injection or earlier surgery

Why see Mr Edwards?

I am a Consultant Hand, Wrist and Elbow Surgeon and Clinical Lead for Hand Surgery at Barts Health NHS Trust, and I chair the British Society for Surgery of the Hand Trauma Committee. I see private patients at Cleveland Clinic London, Moorgate, where assessment, injection and surgery take place on one site. I have a special interest in musicians, performers and athletes, for whom grip and fine finger control matter most.

Frequently asked questions

Will carpal tunnel syndrome go away on its own? Sometimes, in mild cases and in pregnancy. NHS figures show about a third of people improve within 6 months without treatment. Constant numbness or weakness should not be left.

Is the operation done awake? Usually yes, under local anaesthetic. You feel the injection, then nothing sharp during the operation.

Can both hands be done at once? It is possible, but most people prefer one hand at a time so they keep one hand free for daily tasks.

Can it come back after surgery? Recurrence is uncommon. About 30 in 1,000 people need a second operation for any reason.

Do I need a referral? You can book directly, or ask your GP or insurer for a referral. Most insurers ask for a GP referral first.

​

Book a consultation: 020 3423 7183 or contact the clinic.

​

Related reading: 

Numbness in fingers: is it carpal tunnel syndrome?

Driving after hand surgery

Sources

bottom of page