Condition
Carpal Tunnel Syndrome
Test the whole nerve path before splinting the wrist.
3–6%
of adults have carpal tunnel syndrome
A nerve can be compressed anywhere from the neck to the palm. Confirming that the wrist is genuinely the site — rather than assuming it — is what makes conservative treatment work.
What it feels like
- Numbness and tingling in the thumb, index, middle, and half the ring finger
- Symptoms that wake you at night and improve with shaking the hand
- Weakness in grip, dropping objects, difficulty with buttons and jar lids
- Aching that travels up the forearm
- Thenar muscle wasting at the base of the thumb in longstanding cases
What tends to cause it
- Median nerve compression within the carpal tunnel at the wrist
- Sustained or repetitive wrist flexion and extension under load
- Fluid retention from pregnancy, thyroid disease, or diabetes
- Cervical nerve root involvement mimicking or contributing to symptoms
- Compression at the pronator teres in the forearm
- Thoracic outlet involvement at the neck and first rib
The median nerve travels from your neck, through the shoulder, down the arm, past the elbow, through the forearm, and into the hand via a tunnel at the wrist formed by the carpal bones and a thick transverse ligament.
That tunnel is genuinely tight — nine tendons and the nerve share a space with no capacity to expand. When anything increases pressure inside it, the nerve is the softest structure present and it complains first.
The part that gets skipped
“Numb hand” gets treated as “carpal tunnel” far too readily. But the median nerve can be compressed at multiple points, and each produces a slightly different presentation:
- Cervical radiculopathy at C6/C7 — often neck pain, symptoms following a dermatomal band down the arm, may include reflex changes.
- Thoracic outlet — symptoms worse with the arm overhead, often involves the whole hand rather than a median distribution.
- Pronator teres entrapment — forearm pain prominent, and unlike carpal tunnel, sensation over the thenar eminence itself is affected.
- Carpal tunnel — classic median distribution, night waking, relieved by shaking.
The finger distribution alone is highly diagnostic. The median nerve does not supply the little finger. If your little finger is numb, something else is going on and a wrist splint will not touch it.
Double crush
A nerve compressed mildly at two separate points along its length can produce symptoms that neither compression would generate independently. Axonal transport is impaired at the first site, leaving the nerve less able to tolerate the second.
Practically, this means a patient with mild cervical involvement and mild wrist compression may get an incomplete result from wrist treatment alone, and then be told conservative care failed. It did not fail. It only addressed half the problem.
When to stop trying conservative care
If you have constant numbness rather than intermittent, measurable weakness, or visible wasting of the muscles at the base of your thumb, the nerve has sustained meaningful damage and time matters. That is a hand surgeon conversation, and we will make the referral rather than keep you on a treatment plan.
How we treat it here
Test the full path
Neck, thoracic outlet, pronator teres, and carpal tunnel. Median nerve symptoms can originate at any of these and the treatment differs completely. Skipping this is the most common reason carpal tunnel treatment fails.
Check for a double crush
A nerve mildly compressed at two points along its length produces symptoms neither point would cause alone. Cervical involvement alongside wrist compression is common and it explains a lot of incomplete responses to wrist-only care.
Mobilise the nerve and the tissue
Nerve gliding, soft tissue work through the flexor compartment, carpal bone mobilisation, and treatment of the cervical spine and first rib where they test positive.
Change the load
Night splinting in neutral is one of the better-supported conservative measures, because most people sleep with flexed wrists. Workstation and grip modification address the daytime contribution.
Carpal tunnel
Questions we get about this.
Why is it worse at night?
Most people sleep with their wrists flexed, which narrows the carpal tunnel considerably. Fluid also redistributes when you lie flat, raising pressure inside the tunnel. This is why night waking with numbness relieved by shaking the hand is such a characteristic feature — and why a neutral night splint helps so many people so quickly.
Do I need surgery?
Not necessarily, and it depends heavily on severity. Mild to moderate cases frequently respond to conservative care — splinting, nerve gliding, load modification, and treating any contributing sites along the nerve path. Severe cases with constant numbness, significant weakness, or thenar wasting have a much better outlook with surgical release, and delay risks permanent change. We will tell you honestly which category the exam puts you in.
My hand is numb but the tests were negative. What now?
Then something other than the carpal tunnel is likely responsible. Cervical radiculopathy at C6 or C7, thoracic outlet syndrome, pronator teres entrapment, and ulnar nerve involvement all produce hand symptoms. Which fingers are involved is highly informative — the little finger is not served by the median nerve at all, so numbness there points elsewhere entirely.
Is typing the cause?
Less than the reputation suggests. Research examining computer use and carpal tunnel syndrome has not found the strong relationship most people assume. Forceful, repetitive, vibratory work shows a much clearer association. Keyboard use may aggravate existing symptoms without being the origin.
New patient special — $59 New Patient Visit
Get your carpal tunnel properly examined.
One visit, a real diagnosis, and a plan with a visit count and an end date. If it turns out we are not the right provider, we will say so and point you to who is.
Columbus, OH · Same-week appointments · Most insurance accepted