Updated: 5 hours ago
The the main carpal tunnel symptoms and signs to look for are straightforward and easy to spot. If your hand hurts or your fingers go numb, then you might have this condition. But these symptoms aren't a definitive diagnosis because a few other hand problems can be the culprit.
A progressive disorder
Carpal tunnel only worsens without treatment
Carpal tunnel syndrome is a progressive disorder. That means it worsens without treatment in the majority of people who get it. If you let it get to the severe stage, it's much more difficult to treat. At that point, your hand may turn into a nearly useless appendage with only a fraction of its former function.
When you allow carpal tunnel to reach that point, there's little chance anyone can fix the problem. That's because your median nerve is so damaged that it's too far gone for any repair - even surgery. The median nerve is so damaged that it's essentially dead.
Carpal tunnel syndrome is incurable
What most people (and even some doctors) don't appreciate is that carpal tunnel syndrome is incurable. That's not to say you can't conquer it. In a way, it's like diabetes. Nobody can cure diabetes. But with insulin and pills, you can teat it so that symptoms don't take over.
Similarly, carpal tunnel can be treated quite well. You have both surgical and non-surgical options to choose from. The key is to not allow carpal tunnel symptoms to get too far along. The quicker you treat it, the better your treatment results.
In the mild stage, carpal tunnel is quite easy to treat. But having severe symptoms means the median nerve is already badly damaged.
But unfortunately, most people don't rush to treat carpal tunnel when it's in the mild stage. In fact, even though the warning signs of carpal tunnel are well known, most people ignore them until the condition is in the severe stage.
The amazing fact is that early treatment (when in the mild or moderate stage) is almost 100% successful. In contrast, waiting and treating severe carpal tunnel syndrome is much more difficult. And the outcome may not be as good.
Many people (and doctors too) delay treatment because they confuse symptoms with wrist tendinitis. And the vast majority of people just assume their hand is overworked or tired. With a little rest, the problem will go away, right? It usually won't - and you've lost valuable time.
Therefore, early treatment is key. And knowing the most common carpal tunnel symptoms is the first step to attacking the problem before it worsens.
Who's at risk for getting carpal tunnel?
Absolutely anybody can develop carpal tunnel syndrome. But some people are more prone than others. The major risk factors are:
Workers who use their hands to perform forceful and repetitive movements
Pregnancy (especially in the third trimester)
Family history of carpal tunnel syndrome
Health problems like thyroid disorders and kidney failure
Wrist fracture or dislocation
Having a smaller body frame
Sex (carpal tunnel syndrome is more common in women)
What causes carpal tunnel syndrome?
At it's core, carpal tunnel syndrome is a problem with the median nerve located deep inside your wrist joint. It gets damaged. The damage comes from compression by the tissues around it, especially the flexor tendons.
The flexor tendons run next to the median nerve. They're the ropy structures in your hand that flex your fingers. They compress the median nerve because they have a tendency to inflame and swell. It's that swelling that causes the compression on the nerve.
The gradual tendon swelling starts to push against the median nerve. As swelling increases, the tendons compress the nerve more and more. Eventually, the swollen tendons crush the nerve completely.
What causes tendon swelling?
Hand and finger activity
Nobody is sure what makes flexor tendons swell in the first place. It's almost surely set off by performing rapid, forceful or repetitive work with your hands. Repeated grip-and-release activities of the hand are among the greatest risk factors for getting carpal tunnel symptoms.
As a matter of fact, there are certain jobs that are nearly synonymous with causing carpal tunnel syndrome. You wouldn't normally think about it, but hairdressers, construction workers, food store cashiers, and mouse users all have two things in common. First, the jobs are notorious for requiring extensive grip-and-release activity. Second, workers are particularly vulnerable to getting carpal tunnel.
But hand overwork isn't the whole story behind acquiring this condition. There's a huge body of evidence that carpal tunnel syndrome is hereditary. If a parent or sibling has it, chances are very high that you will, too. It's thought that genetics somehow "sets up" the wrist and tendons to be vulnerable. But exactly how that happens is still a mystery.
Microscopic rips and adhesions
We get carpal tunnel symptoms because of everything that happens inside the confined space of the wrist joint. The end result is that swollen tendons crush the adjacent median nerve. This is the reason you have symptoms of pain, numbness, tingling, soreness, or weakness in your fingers or hand.
But why do overworked tendons react that way? What chemistry or biology causes the inflammation that starts the swelling process?
Under normal conditions, tendons are very resilient. The can contract and relax thousands of times an hour. They can do this because each of them glides inside its own sheath or covering. It's like a pencil gliding in and out of a plastic tube.
But overworking the tendons can put a toll on them. Like actual ropes, tendons strain with tension. The strain produces numerous microscopic rips between the tendon surface and the surrounding sheath.
A normal body repairs those tendon rips quickly. Then the tendon just goes about gliding smoothly inside the sheath again.
But in carpal tunnel syndrome, either the rips are not repaired fast enough or there's a problem with how they're repaired. The body tries to fix the resulting rips, but the repair job doesn't seem to be very effective. The result is that tiny scars form on the tendon's surface.
These scars are almost like little scabs. They take up the space between the tendon's surface and the surrounding sheath. As the scars grow, they become adhesions, effectively gluing tendons to their sheath.
The adhesions make tendon gliding rough and "sticky". That means they're less able to move smoothly. Think of a pencil inside a tube. It would normally glide in and out easily. But if there's wet sand on the pencil, it won't glide as well.
The body doesn't like these adhesions and does it's best to eliminate them. So the body attacks the adhesions with cells and chemicals in order to eliminate them.
This attack on the tendons by the body is what produces inflammation and subsequent swelling.
And if that's not bad enough, each microscopic rip then rips again. Then the body tries to repair the rip once more. As a result, additional adhesions form which cause even more stickiness. It's like a "rip-and-repair" cycle that never stops.
Eventually, the inflammation swelling gets progressively worse The super-swollen tendons expand so much that they crush the neighboring median nerve.
Can we stop the adhesions?
Unfortunately, we cannot stop the adhesions from forming. But there are 2 things that can be done to reduce the swelling and keep carpal tunnel symptoms from worsening.
1. Carpal tunnel surgery
Carpal tunnel surgery tries to relieve the swelling pressure on the median nerve. Surgery opens up the wrist joint and cuts the transverse carpal ligament. That's the main structure that holds the wrist bones together.
Cutting the ligament makes the wrist joint immediately snap open. As a result, excess fluid pressure drains out from deep inside the wrist. As the nerve decompresses, symptoms usually resolve.
But the problem of adhesions isn't addressed by surgery. That's why symptoms usually return. Statistics show that 50% of patients who had carpal tunnel surgery are not pleased with their results 2 years later.
2. Myofascial release massage
Myofascial release is a massage technique used to knead the tissues over the wrist and forearm. This mechanical force pushes the tendons and sheaths in different directions. The result is that it breaks up the adhesions between them.
Another benefit of myofascial release massage is that it drains the excess, pressurized fluid from the wrist joint almost immediately. Simultaneously, it also encourages blood flow which is necessary for healing. Accordingly, the combined effect promotes tendon healing. That, of course, is the foundation to eliminate carpal tunnel symptoms.
Myofascial release massage for carpal tunnel must be applied daily for at least a month to be effective. Anything less will not product the proper effect. But with daily treatment for a month, the body is able to eliminate the adhesions on it's own more effectively. That's the reason symptoms don't return so readily after a course of myofascial release massage therapy.
Carpal tunnel diagnosis
Doctors use "provocative tests" to easily diagnose carpal tunnel syndrome. In general, these are the Phalen, Tinel, and Durkan tests. They're called provocative tests because each test tries to provoke or enhance the symptoms you already have.
The one thing these 3 tests have in common is that they're all "compressive" tests. In other words, they temporarily super-compress the median nerve. If symptoms can be provoked by doing that, it means you probably have carpal tunnel syndrome.
Today, most doctors have come to rely on the provocative tests because they can diagnose carpal tunnel syndrome with relatively high accuracy. If the examiner is experienced and consistent, his or her diagnosis by provocative testing can be more accurate than any other diagnostic method.
For the most part, patients with carpal tunnel syndrome show signs of nerve conduction abnormalities. This the reason doctors have historically relied on electrodiagnostics or EDX tests to confirm carpal tunnel syndrome. These tests mainly include the nerve conduction velocity (NCV) test and electromyography (EMG).
However, studies show these tests give too many false positive results. (That means the tests indicate carpal tunnel, when it is not actually be the problem at all.) For this reason, over recent years these tests have fallen out of favor with doctors.
Why is that important? It's because those patients who are misdiagnosed as having carpal tunnel are referred to hand surgery. But in reality, many don't have carpal tunnel and therefore don't need carpal tunnel surgery!
What's more, other studies show the provocative tests are better at diagnosing the condition. And provocative tests cost practically nothing compared to expensive and unnecessary EDX tests.
MRI, X-ray and ultrasound are not tremendously reliable in predicting carpal tunnel syndrome. That's why they cannot be used as the sole diagnosis for this condition. In fact, they don't even approach the accuracy of the old fashioned provocative tests. But many doctors still rely on medical imaging to confirm their diagnosis of carpal tunnel.
Lately, given their expense and commitment of time, a majority of doctors are not relying on imaging tests to confirm their carpal tunnel diagnosis.
Most common carpal tunnel symptoms
1. Time course & location of symptoms
Most doctors classify carpal tunnel syndrome's severity as mild, moderate or severe. And as roaringly bad as carpal tunnel can get, it normally starts off with a whimper.
When carpal tunnel symptoms begin, patients usually don't notice anything at all. As symptoms start to show up more often, they usually attribute it to overworked or tired hands.
Importantly, characteristics of the early signs distinguish carpal tunnel from similar conditions like wrist tendinitis. Unlike tendinitis, carpal tunnel symptoms happen at rest, like when you're sleeping or sitting quietly. In contrast, tendonitis symptoms usually appear only while using your hand.
The time it takes for carpal tunnel to progress from mild to severe is different from one person to another. But generally, it takes about 6 months.
The rate that symptoms worsen also varies. For instance, some see symptoms go from barely felt to severe in just a couple months. But in others it might take 2 or more years. Symptoms may linger in a mild form for a long time and then worsen suddenly. Or they could escalate steadily.
Carpal tunnel symptoms most frequently begins on the palm side of the index and middle fingers. Also, half of the ring finger has symptoms (on the thumb-side of that finger). In most people, the thumb itself is more severe than the other fingers. However, symptoms never appear on the fifth (little) finger.
If symptoms start in one hand, then 80% of the time they'll also occur in the opposite hand. Doctors call that “bilateral carpal tunnel syndrome“. Symptoms on the opposite hand can start simultaneously. But normally they appear within 6 months of each other.
2. Mild carpal tunnel: what early symptoms feel like
Mild numbness or tingling
The early symptoms of carpal tunnel syndrome constitute the mild stage of the condition. The most common early signs carpal tunnel are numbness or tingling in the hands or fingers. Usually the fingertips are the first to feel numb or tingly.
Some patients may have feelings like electric shocks in the index, middle or ring fingers. Oftentimes, patients will describe it as a tingling or pins-and-needles feeling.
Sometimes the numbness or tingling can travel from your wrist up your arm. These symptoms most often happen while holding a steering wheel, phone or newspaper. Bending your hand forward or back too far can produce numbness as well.
Other patients report constant burning, itching or soreness. Yet others say their hand or fingers feel puffy. But the puffy carpal tunnel symptoms are just feelings; there is no actual swelling or puffiness.
In most cases mild symptoms don't appear during the day, while your hand is working. They only appear when your hand is resting.
Usually symptoms happen so gradually that the first realization of a problem is when trying to sleep at night. Patients wake up with numbness and try to shake it out. As a result, many people lose sleep because they awaken and have to shake out their hands several times each night.
This is the point where most patients realize they have a problem. They also realize they have functional problems with their hands in the form of weakness.
The majority of carpal tunnel patients experience some weakness in the hand. The weakness is accompanied with feelings of hand or finger clumsiness. There's a tendency to drop objects. Some patients find that it's difficult to open jars, tie shoelaces, button a shirt or pick up coins. Turning a doorknob is no longer a simple task.
Some of weakness is due to reduced abilities of your thumb muscles. The muscles used for pinching (controlled by the median nerve) don't function due to the compressed nerve.
Even in the mild stage, pain can be a main symptom of this condition. It too will likely begin while trying to sleep.
Patients describe carpal tunnel pain differently. Some say the pain is dull and throbbing. Others say it's sharp and piercing. Yet others describe pain from carpal tunnel syndrome as a crushing feeling. They say their hand feels like it's in a vice. It's also common for patients to report pain radiating up the arm.
3. Moderate carpal tunnel: what moderate symptoms feel like
As the swollen tendons gradually crush the median nerve, carpal tunnel symptoms worsen. The hallmark of moderate stage carpal tunnel is when symptoms creep into the daytime instead of only at rest. Also, patients may begin to lose the sensation of hot or cold on their fingertips.
Moderate numbness or tingling
These symptoms are nearly identical to those in the early stage of carpal tunnel. The difference is that the symptoms are constant (happening day and night) and are more intense.
In addition, bending the hand forward or backward even a little makes symptoms worse. Holding a phone or steering wheel will almost always worsen the problem.
The strength of your hand continues to decline with moderate carpal tunnel. In fact, loss of grip strength is one of the first complaints doctors hear.
The hand weakness at this stage makes it difficult to pick up heavier objects. Mothers can no longer pick up their child. Patients drop things more and more often. Holding a toothbrush or coffee cup is noticeably difficult.
Carpal tunnel usually affects the muscles at the base of thumb. So as the condition worsens, it's difficult to use your thumb fully. It's almost impossible to touch your thumb to your little finger.
If pain was not an early sign, then it likely begins now. The pain sensations are similar to those felt in the mild stage.
In the moderate stage, the level of pain can increase gradually or quickly. It may only be annoying pain or else it can be crushingly severe. In this stage, pain may even take over numbness as the primary symptom. The pain will also likely be present day and night.
Moderate loss of temperature sensation
As carpal tunnel symptoms progress, some patients start to lose the sensation of hot or cold on their fingers. The loss is usually not too severe at this stage, but it is noticeable. This is why carpal tunnel patients are warned to be careful cooking or being around hot water.
4. Severe carpal tunnel: what severe symptoms feel like
A sure sign that the condition is in the severe stage is when carpal tunnel symptoms are maximally uncomfortable or painful all day and all night. In general, that means there's no break from it. It has gone from an inconvenience to a major interference in your life.
The severe stage is when most patients ask to have surgery. But ironically, the more severe the carpal tunnel, the less likelihood surgery will be successful.
Severe numbness or tingling
The numbness in this stage is so intense it's the reason most people say they want to "cut their hand off" to relieve it. Also, the feeling of swollen or puffy fingers or hands may increase greatly.
It's common for severe stage patients to experience carpal tunnel symptoms in combination of 2 or more symptoms. That means they can have any mixture of numbness, pain, burning, soreness, itching or tingling.
Some people try using ice baths to relieve the discomfort. However, ice baths provide only temporary relief.
When the condition progress to the severe stage, all hand function decreases dramatically. Overall loss of grip strength and dexterity dominates a patient's daily life. The hand is more clumsy and weaker than ever.
Fine dexterity also largely disappears. Many patients require assistance to bathe, toilet, and dress.
At this point, any pain symptoms are usually constant. But even at the severe stage, finger or hand pain may never occur. That leaves only numbness or tingling feelings. But such is rare.
When pain is the predominant symptom, it's excruciating. Pain relievers like Tylenol or Advil are relatively useless. Steroid shots can relieve pain, but the effect is usually temporary, lasting one to several weeks. Steroid shots can only be given in limited amounts due to side effects.
Severe loss of temperature sensation
In the severe stage, the affected hand may get so numb that patients lose all ability to feel hot or cold. They must take extreme care around hot water or appliances. When loss of temperature sensation is so complete, almost any treatment to reverse carpal tunnel is extremely difficult.
The end-stage of severe carpal tunnel syndrome is heralded by advanced muscle loss. The muscles at the base of the thumb are in their final stages of degeneration. They slowly waste away.
That means there's noticeable muscle loss at the base of the thumb. The thumb muscles appear flat or wrinkled. Any useful function of the thumb and most of the fingers is almost impossible.
For the most part, carpal tunnel symptoms begin as numbness and tingling in the hand and fingers. As the condition progresses to the severe stage, symptoms usually include intolerable numbness or excruciating pain. Patients will most likely also experience a loss of grip strength and dexterity, as well as the inability to sense hot and cold temperatures in the hand and fingers.
Dr. Z (Dr. Maik Zannakis) is a neurophysiologist and bio-engineer with over 40 years of research experience. His primary focus is discovering methods to heal tissues damaged by pathology or injury. An expert in the nervous system, Dr. Z has hundreds of publications and dozens of international patents for products and techniques to restore body parts like the brain, spinal cord, nerves, and tendons. The Carpal Rx is his most recognized invention, helping thousands eliminate the symptoms of carpal tunnel syndrome without surgery.