For many people, the first sign of carpal tunnel syndrome isn’t pain-it’s numbness. You wake up in the middle of the night, shaking your hand like you’re trying to get water out of your palm. Your thumb, index, and middle fingers feel like they’re asleep. You rub them, roll your wrist, and after a few seconds, the feeling comes back. It happens again the next night. And the next. Soon, it’s not just at night. It’s while you’re typing, holding a coffee cup, or turning a doorknob. If this sounds familiar, you’re not alone. Carpal tunnel syndrome affects about 10% of the U.S. population, and it’s one of the most common nerve compression disorders in the body.

What Exactly Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome happens when the median nerve gets squeezed inside the carpal tunnel-a narrow passageway at your wrist made of bones and a tough ligament. This tunnel isn’t just for nerves. It also holds nine tendons that bend your fingers and thumb. When pressure builds up inside, the median nerve, which controls sensation and movement in your thumb and first three fingers, starts to malfunction.

The problem isn’t usually one big injury. It’s slow, repetitive stress. Think typing all day, gripping tools, or bending your wrist repeatedly while working on an assembly line. Women are three times more likely to develop it than men, especially between ages 45 and 60. Hormonal changes, pregnancy, and even genetics can play a role. The real danger? Left untreated, the nerve doesn’t just get irritated-it starts to lose its insulation (demyelination) and can even begin to die (axonal damage). That’s when numbness turns permanent.

How Do You Know It’s Carpal Tunnel and Not Something Else?

Not all hand numbness is carpal tunnel. Pinched nerves in the neck, arthritis, or even diabetes can cause similar symptoms. But CTS has a clear pattern. The numbness and tingling hit the thumb, index, middle, and half of the ring finger-exactly where the median nerve runs. The little finger? Usually untouched. That’s a key clue.

Early signs are nighttime symptoms. You wake up because your hand feels like it’s on fire or asleep. Shaking it helps. Later, you’ll notice weakness. Dropping things. Difficulty buttoning shirts. Opening jars. The thenar muscles at the base of your thumb start to shrink-that’s a late sign, and it means the nerve has been under pressure for a long time.

Doctors use a few simple tests to check. The Phalen test: bend your wrists forward for a minute. If tingling shoots in, it’s a red flag. The Tinel sign: tap the inside of your wrist. A shock-like feeling in your fingers? That’s another. The carpal compression test: press directly on the tunnel for 30 seconds. If symptoms flare, it’s likely CTS.

For confirmation, electrodiagnostic tests like nerve conduction studies are the gold standard. If your median nerve takes longer than 3.7 milliseconds to send a signal across the wrist, that’s diagnostic. But here’s the catch: 15-20% of people over 60 have abnormal nerve tests but no symptoms. That’s why doctors don’t rely on tests alone. They match the results with your symptoms and physical exam.

Conservative Treatments: What Actually Works?

If you’re in the early or moderate stage, you don’t need surgery. In fact, most people get better without it. The first-line treatment? A wrist splint worn at night.

Wearing a splint that keeps your wrist straight (not bent) while you sleep reduces pressure on the nerve. Studies show 60-70% of people with mild to moderate CTS see big improvement after just 4-6 weeks of consistent use. The key? You have to wear it every night. Not just when it hurts. Not just a few nights. Every night. For at least 6-8 weeks.

Activity changes matter too. Avoid bending your wrist more than 30 degrees. That means adjusting your keyboard height, switching from a mouse to a vertical mouse, or using voice commands. Take breaks every 20 minutes. Stretch your hands. Roll your wrists. Do nerve gliding exercises-these gently move the median nerve back and forth to keep it from sticking to surrounding tissue.

Corticosteroid injections are another option. A shot of steroid into the carpal tunnel can reduce swelling and give relief for 3-6 months. About 70% of people respond. But it’s not a cure. It’s a pause button. If your symptoms return after a few months, you’re back to square one. And repeated injections aren’t recommended-they can damage the nerve over time.

Physical therapy is often overlooked. A good therapist will teach you how to move your wrist without triggering pressure, how to strengthen your hand without overloading it, and how to modify your work environment. Most people need 2-4 sessions to get it right. The cost? Around $100-$200 per session, with 4-6 sessions typical. Total conservative care-including splint, therapy, and one injection-runs $450-$750 in the U.S.

When Surgery Becomes Necessary

Surgery isn’t a last resort-it’s the right choice when conservative treatments fail or when nerve damage is already happening. If you’ve had symptoms for over 10 months, your chances of recovery without surgery drop to 35%. If you’re losing muscle mass in your thumb, surgery is urgent.

The two main types are open release and endoscopic release. Open release means a 2-inch incision along the palm, cutting the ligament that’s squeezing the nerve. Endoscopic uses one or two small cuts and a camera to do the same job from inside. Endoscopic recovery is faster-most people get back to light work in 2-3 weeks instead of 4-6. But it costs 15-20% more.

Success rates are high: 90-95% of patients report significant improvement. But it’s not perfect. About 15-30% get pillar pain-tenderness on the sides of the palm where the ligament was cut. Scar sensitivity happens in 5-10%. Nerve injury is rare-under 1%.

Recovery takes time. You’ll need 6-8 physical therapy sessions over 4-6 weeks. If you do manual labor, expect 10-12 weeks before returning to full duty. Most people can drive again in a week and type within two weeks.

Newer Options: Ultrasound and Minimally Invasive Techniques

Technology is catching up. In 2021, the FDA approved a device called the SX-One MicroKnife, which uses ultrasound guidance to cut the ligament through a tiny needle-sized incision. No big cut, no stitches. Patients report 40% less pain after surgery and return to work 50% faster.

Ultrasound imaging is also changing diagnosis. Instead of waiting for nerve tests, some clinics now use high-resolution ultrasound to measure the size of the median nerve at the wrist. If it’s larger than 12mm², that’s a strong indicator of CTS. Sensitivity? 92%. Specificity? 88%. That means fewer false positives and faster decisions.

The American Academy of Neurology now says ultrasound can be a first-line diagnostic tool-if your clinic has the right equipment and trained staff. It’s not everywhere yet, but it’s growing fast.

Why Early Action Matters

The biggest mistake people make? Waiting. They think, “It’ll go away.” Or, “I’ll just tough it out.” But nerves don’t heal like muscles. Once the myelin sheath is gone and axons start dying, the damage is permanent. You might feel better after surgery, but you won’t get full sensation back.

Studies show that people who start conservative care early-within the first 3-6 months-have a 45% lower chance of needing surgery two years later. That’s huge. Splinting, stretching, and ergonomic changes aren’t just temporary fixes. They’re prevention tools.

Workplace factors matter too. Manufacturing, healthcare, and food service workers have the highest rates. OSHA doesn’t have specific CTS rules in the U.S., but in the EU, employers must assess repetitive motion risks. If you’re in a high-risk job, talk to your HR department. Simple changes-like rotating tasks, using ergonomic tools, or taking micro-breaks-can make a difference.

What Doesn’t Work

There’s a lot of noise out there. Yoga? Maybe helps with stress, but it won’t un-squeeze a nerve. Acupuncture? Some people feel better, but no solid evidence it changes nerve function. Supplements like B6? Studies show no benefit beyond placebo. Anti-inflammatory diets? Good for overall health, but won’t fix carpal tunnel.

And don’t fall for “miracle” wrist braces sold online that claim to cure CTS in a week. If it doesn’t hold your wrist in a neutral position, it’s useless. Stick to medical-grade splints. They’re not cheap, but they’re proven.

What to Do Next

If you’re having nighttime numbness, tingling, or weakness in your hand, don’t wait. Start with a splint tonight. Buy one from a pharmacy or online that keeps your wrist straight-not bent. Wear it every night for at least 6 weeks. Cut back on repetitive wrist motions. Use voice-to-text if you type a lot. See a doctor if symptoms don’t improve in 2-3 weeks.

If you’ve had symptoms for more than 6 months, or if your thumb muscles look sunken, get an evaluation now. Nerve damage doesn’t reverse. But early action? That’s your best shot at keeping your hands working for years to come.