Carpal Tunnel Syndrome

Diagnosis and treatment of median nerve compression at the wrist, Lahore, Pakistan

Why Do My Hands Go Numb at Night?

The carpal tunnel is a narrow passageway on the palm side of the wrist, bounded by small wrist bones on one side and a tough, unyielding ligament (the transverse carpal ligament) on the other. The median nerve — which supplies sensation to the thumb, index, middle, and part of the ring finger, and controls some of the small muscles at the base of the thumb — passes through this tight tunnel along with nine tendons that bend the fingers.

Because the tunnel is a fixed, confined space, any swelling of the tendons or their lining reduces the room available for the nerve, and the nerve is the structure that suffers. This is also why symptoms are so often worse at night: during sleep, many people curl their wrists into a bent position, and fluid tends to redistribute into the hands when lying flat, both of which raise pressure inside the tunnel and irritate the already-compressed nerve. Many patients describe waking repeatedly to shake or flick the hand for relief — a symptom doctors call the "flick sign" and one of the more reliable pointers toward carpal tunnel syndrome.

Carpal tunnel syndrome is one of the most common peripheral nerve conditions, and while it can affect anyone, it is more frequent in people who perform repetitive hand movements, and in conditions such as diabetes, hypothyroidism, and pregnancy.

Dr. Waqas Mehdi, FCPS Neurosurgeon at MidCity Hospital Lahore, manages peripheral nerve conditions including carpal tunnel syndrome — from clinical diagnosis and conservative treatment through to surgical release when needed.

Symptoms of Carpal Tunnel Syndrome

!Numbness or tingling in the thumb, index, and middle fingers
!Symptoms often worse at night, sometimes waking you from sleep
!Weak grip or a tendency to drop objects
!A sensation of swelling in the fingers, even when no swelling is visible
!Pain that may radiate up the forearm
!Difficulty with fine tasks like buttoning a shirt or holding a phone
!Muscle wasting at the base of the thumb (in advanced, longstanding cases)
!Relief from shaking or repositioning the hand

Carpal Tunnel Syndrome vs Cervical Radiculopathy — How to Tell the Difference

Hand numbness and tingling are not always coming from the wrist. A pinched nerve in the neck (cervical radiculopathy, often caused by a herniated disc or spondylosis) can send numbness down the arm into the hand and is one of the most common reasons carpal tunnel syndrome is misdiagnosed, and vice versa. Since both conditions are common and can even coexist in the same patient — sometimes called "double crush" — telling them apart matters for choosing the right treatment.

Distribution of numbness: Carpal tunnel syndrome classically affects the thumb, index, middle, and half of the ring finger, sparing the little finger. Cervical radiculopathy (particularly C6-C7-C8) often involves the ring and little fingers, or a broader strip down the forearm, depending on which nerve root is affected.
Neck symptoms: Neck pain, stiffness, or pain that radiates from the neck down the arm points toward a cervical cause. Carpal tunnel syndrome does not usually cause neck pain.
Effect of position: Cervical radiculopathy symptoms often change with neck movement or position (for example, worse when looking up or turning the head). Carpal tunnel symptoms are more closely tied to wrist position and hand use, and classically worse at night regardless of neck posture.
Examination findings: Tinel's and Phalen's tests at the wrist point to carpal tunnel syndrome, while a positive Spurling's test (reproducing arm symptoms with neck extension and rotation) points toward a cervical nerve root problem.
Confirmatory tests: A nerve conduction study/EMG can identify slowing specifically at the wrist (carpal tunnel) versus a pattern affecting a whole nerve root distribution. An MRI of the cervical spine is used when a neck cause is suspected.

If you have hand numbness together with neck pain, or numbness that does not fit the classic carpal tunnel pattern, it is worth having both the wrist and the neck assessed. Read more about neck pain and cervical nerve compression.

Who Is at Risk of Carpal Tunnel Syndrome? (Pregnancy, Diabetes, Repetitive Work, Hypothyroidism)

Pregnancy

Fluid retention and hormonal changes in later pregnancy commonly cause swelling that raises pressure inside the carpal tunnel. Symptoms often appear in the second or third trimester and, in most women, ease within weeks to months of delivery as fluid balance returns to normal.

Diabetes

Diabetic nerves are more vulnerable to compression injury than healthy nerves, so people with diabetes both develop carpal tunnel syndrome more often and may notice symptoms at an earlier stage of compression. Good blood sugar control is an important part of management.

Hypothyroidism

An underactive thyroid can cause tissue swelling (including within the carpal tunnel) and is a recognised, sometimes reversible, contributor to carpal tunnel syndrome — one reason thyroid function is often checked when the cause is unclear.

Repetitive Hand & Wrist Movements

Prolonged typing, assembly-line or manual labour work, and regular use of vibrating power tools are associated with a higher risk, likely through repeated strain and swelling of the tendons that share space with the median nerve.

Obesity

Higher body weight is an independent risk factor for carpal tunnel syndrome, thought to relate to both generalised tissue swelling and mechanical factors within the wrist.

Rheumatoid Arthritis & Other Inflammatory Conditions

Inflammatory arthritis affecting the wrist can cause swelling of the joint lining and tendon sheaths, narrowing the carpal tunnel and compressing the nerve.

Diagnosis

Clinical Examination: Specific bedside tests (such as Tinel's sign and Phalen's test) reproduce symptoms by tapping over or flexing the wrist, supporting the diagnosis alongside the symptom pattern described by the patient.
Nerve Conduction Study / EMG: The key confirmatory test — measures how well electrical signals travel through the median nerve at the wrist, confirming the diagnosis and grading its severity.
Ultrasound of the Wrist: Can show swelling of the median nerve at the wrist and is increasingly used alongside nerve conduction studies.
Blood Tests: Sometimes checked to identify an underlying contributing cause, such as diabetes or thyroid dysfunction.

Nerve Conduction Study — What to Expect

Many patients feel anxious before their first nerve conduction study, so it helps to know what actually happens. The test is performed by a neurophysiologist or trained technician and generally takes about 20 to 30 minutes for both hands.

Small flat electrodes are taped onto the skin over the wrist, palm, and fingers, and a brief, mild electrical impulse is delivered through the skin to stimulate the nerve while the machine records how quickly and strongly the signal travels. The sensation is usually described as a quick tapping or tingling "buzz" rather than a painful shock, and each stimulation lasts only a fraction of a second. Some parts of the study may also involve a fine needle electrode placed briefly into a muscle (the EMG component) to check muscle response directly, which causes brief discomfort similar to a small pinch.

There is no sedation, no needles left in place, and no recovery time needed — patients can drive and return to normal activity immediately afterward. Results are usually available the same day and are reviewed together with the clinical findings to confirm the diagnosis and grade how severe the nerve compression is.

When Does Carpal Tunnel Need Surgery vs a Wrist Splint?

Wrist Splinting

A neutral-position wrist splint, worn especially at night, reduces pressure on the median nerve and is often the first treatment tried for mild to moderate symptoms, particularly when symptoms are intermittent and there is no thumb muscle wasting.

Activity Modification & Physiotherapy

Adjusting repetitive hand movements, ergonomic changes at work, and nerve-gliding exercises can help reduce symptom severity, especially when a clear repetitive-strain trigger is identified.

Corticosteroid Injection

An injection into the carpal tunnel can provide temporary but often significant relief, and can also help confirm the diagnosis when the response is dramatic. It is a reasonable option for patients wanting to delay or avoid surgery, though relief is often not permanent.

Carpal Tunnel Release Surgery

Surgery becomes the recommended option when symptoms are severe, constant rather than intermittent, have not responded to splinting or injections, or when there are objective signs of nerve damage on examination or nerve conduction study — particularly weakness or wasting of the thumb muscles, which signals the nerve is being damaged and conservative treatment is unlikely to reverse this on its own.

Carpal Tunnel Release Surgery — Open vs Endoscopic, and Recovery

Carpal tunnel release surgery divides the transverse carpal ligament that forms the roof of the tunnel, giving the median nerve more room and relieving the pressure causing symptoms. It is typically done as a day-case procedure under local anaesthesia (sometimes with light sedation), meaning patients go home the same day.

Open release: A small incision, usually a few centimetres long, is made at the wrist crease extending into the palm, allowing the ligament to be divided under direct vision. This is the traditional, well-established technique with a long track record.
Endoscopic release: Performed through one or two much smaller incisions using a small camera and instrument to divide the ligament from underneath. This can mean less scar tenderness and a quicker return to normal hand use for some patients, though the choice of technique depends on individual anatomy and surgeon assessment.

After surgery, the hand is usually bandaged for a few days to a couple of weeks, with stitches removed or dissolving over roughly 10-14 days. Light use of the hand — eating, writing, basic self-care — is often possible within days, while heavier gripping, lifting, or manual work is generally built back up over 4 to 6 weeks.

Recovery of sensory symptoms (the numbness and tingling) is often relatively fast, sometimes noticeable within days to weeks, since the nerve's ability to conduct sensation frequently improves quickly once pressure is removed. Recovery of strength, particularly if there was visible wasting of the thumb muscles before surgery, is slower and less predictable — motor nerve fibres and muscle bulk take longer to recover, and in cases of longstanding severe compression, some weakness may persist despite a technically successful operation. This is one of the main reasons earlier surgery is generally preferred once it is clearly indicated, rather than waiting until wasting has already developed.

Frequently Asked Questions

What is carpal tunnel syndrome?
Carpal tunnel syndrome is a common nerve compression condition in which the median nerve — which runs from the forearm into the hand through a narrow passage in the wrist called the carpal tunnel — becomes compressed, causing numbness, tingling, and weakness in the hand.
Who treats carpal tunnel syndrome in Lahore?
Dr. Waqas Mehdi, FCPS Neurosurgeon and Assistant Professor at KEMU/Mayo Hospital, Lahore, treats carpal tunnel syndrome and other peripheral nerve entrapment conditions, from conservative management to surgical release.
What are the symptoms of carpal tunnel syndrome?
Common symptoms include numbness and tingling in the thumb, index, middle, and part of the ring finger; hand weakness, especially gripping objects; a tendency to drop things; and symptoms that are often worse at night, sometimes waking the person from sleep.
Can carpal tunnel syndrome be cured without surgery?
Mild to moderate cases can often be controlled — and sometimes fully resolved, especially if a reversible cause such as pregnancy or hypothyroidism is treated — with night splinting, activity modification, and occasionally a corticosteroid injection. Long-standing, severe compression with constant numbness or thumb muscle wasting is unlikely to fully reverse without surgical decompression.
How long does carpal tunnel surgery recovery take?
Most patients go home the same day. The skin incision typically heals within 2 weeks, and light one-handed activities can often resume within days. Return to full unrestricted use, including heavier gripping or manual work, is usually advised over 4 to 6 weeks, though this varies with the type of work and how longstanding the compression was before surgery.
Can carpal tunnel come back after surgery?
Recurrence is uncommon but possible, particularly if the underlying contributing factor (such as poorly controlled diabetes or ongoing repetitive strain) persists, or in a small percentage of cases due to scar tissue reforming around the nerve. Most patients who undergo carpal tunnel release experience durable, long-term relief.
Is carpal tunnel syndrome permanent if left untreated?
If severe compression is left untreated for a long time, the median nerve can sustain permanent damage, leading to persistent numbness and wasting of the thumb muscles that may not fully recover even after surgery. This is why early diagnosis and treatment matter — outcomes are best when surgery is done before permanent nerve or muscle damage sets in.
Can pregnancy-related carpal tunnel go away after delivery?
Yes, in many cases. Carpal tunnel syndrome in pregnancy is usually caused by fluid retention and swelling, and symptoms frequently improve or resolve within a few weeks to months after delivery as fluid balance normalises. Splinting is generally preferred over surgery during pregnancy unless symptoms are severe.
How can I tell if my hand numbness is from carpal tunnel or a neck problem?
Carpal tunnel syndrome classically affects the thumb, index, and middle fingers and spares the little finger, is often worse at night, and is not usually associated with neck pain. Numbness from a pinched nerve in the neck (cervical radiculopathy) often follows a different pattern, may include the ring and little fingers, is frequently accompanied by neck or shoulder pain, and can change with neck position. A clinical examination, and sometimes a nerve conduction study combined with an MRI of the neck, can distinguish the two.

Hand Numbness or Tingling at Night?

Don't wait for permanent nerve damage or muscle wasting. Consult Dr. Waqas Mehdi for an accurate diagnosis and the right treatment plan. MidCity Hospital, Lahore — Mon to Sat, 6–8 PM.

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