Early symptoms of carpal tunnel syndrome

The early symptoms of carpal tunnel syndrome (CTS) include nighttime occurrences such as numbness, tingling, and/or pain in the fingers – especially the thumb, index, and middle fingers. The frequency and intensity of these symptoms increase when people sleep with their wrists curled or flexed, and can be such that the person is awakened from sleep and feel the need to shake their hands or wrists – which relieves the discomfort in the early stages. The first symptoms appear in one (usually the dominant) or both hands during the night, but daytime symptoms may also occur – including tingling and decreased feeling in the fingertips.

Carpal tunnel syndrome symptoms


In the fingers or hand, especially the thumb and index, middle, or ring fingers – but not the little finger; it may also radiate from the wrist up to the arm.  Commonly occurs when holding a steering wheel, phone, book or newspaper.


In the hand or the thumb’s pinching muscles; this can result in a tendency to drop objects.


·         A sensation of swelling even though little to no swelling is observable.

·         Decreased grip.

·         Inability to tell between hot and cold by touch.

·         Inability to perform tasks requiring delicate motions.


CTS occurs when the median nerve – running from the forearm into the palm of the hand through a ligament and bone rigid passageway called the carpal tunnel at the base of the hand – which controls sensations to the palm side of the thumb and fingers (minus the little finger) and impulses to some small hand muscles finger and thumb movement, is compressed at the wrist. Anything that squeezes or irritates the median nerve can cause carpal tunnel syndrome, but especially jobs or activities involving repetitive finger use, in particular those associated with high force, long-term use, extreme wrist motions, and vibration – for instance manufacturing, sewing, finishing, cleaning, and meat, poultry, or fish packing.

Other risk factors include:

·         Heredity (smaller carpal tunnels can run in families).

·         Pregnancy.

·         Hemodialysis.

·         Wrist fracture and dislocation.

·         Hand or wrist deformity.

·         Inflammatory diseases (rheumatoid arthritis, gout).    

·         Thyroid gland hormone imbalance (hypothyroidism).    

·         Diabetes.

·         Alcoholism.

·         A mass in the carpal tunnel.

·         Older age.

·         Gender (women have smaller carpal tunnel areas than men).

·         Alterations in the balance of bodily fluids.

Despite popular belief, there isn’t enough evidence linking CTS to extended computer use. Moreover, assemblers are thrice as likely to develop carpal tunnel syndrome as data entry staff. Nonetheless, the risk of experiencing carpal tunnel syndrome is not exclusive to any one profession. Different tests can be performed in order to determine whether the early symptoms of carpal tunnel syndrome are related to everyday activities or to an underlying cause.

CTS diagnostic tests

Physical examination of the hands, arms, shoulders, and neck

·         The wrist is examined for tenderness, swelling, warmth, and discoloration.

·         Each is should be tested for sensation.

·         The muscles at the base of the hand are examined for strength and signs of atrophy.


Phalen test

Depending on the source it involves either having the patient hold his/her forearms upright by pointing the fingers down and pressing the backs of the hands together; or having the patient rests his/her elbows on a table and allows the wrist to fall forward freely. Either way, the presence of symptoms such as tingling or numbing after 60 seconds suggests CTS.

Tinel’s sign

The doctor taps on the median nerve in the patient's wrist to see whether it produces tingling in the fingers.


·         X-ray.

·         Electromyogram.

·         Nerve conduction study.


Treatment should start as soon as CTS is diagnosed to prevent permanent median nerve damage. Therapy is divided in surgical and non-surgical.

Carpal tunnel syndrome therapy


·         Wrist splints.

·         Nonsteroidal anti-inflammatory drugs.

·         Corticosteroids.

·         Cold packs.


·         Endoscopic surgery.

·         Open surgery.


Furthermore, CTS may be prevented by doing the following:

·         Reducing force.

·         Relaxing grip.

·         Taking quick, frequent breaks from repetitive actions.

·         Not bending the wrist all the way up or down.

·         Improving posture.

·         Keeping hands warm, for instance by wearing fingerless gloves.

·         Rotating the wrists.

·         Stretching exercises.

·         Sleeping with wrists held straight.

·         Keeping wrists straight when using tools.

·         Avoiding flexing and extending wrists repeatedly.

·         Decreasing repetitive/strong grasping with the wrist in a flexed position.

·         Performing on-the-job conditioning and stretching exercises before and after activities.

Related: The Carpal Tunnel and the Intensity Twin Stim III