Carpal tunnel syndrome is compression of the median nerve at the wrist, causing tingling and numbness in the thumb, index and middle fingers, worst at night. A night splint helps a proportion. Injection and surgery both work. A 30 minute consultation is £150.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
The median nerve runs through a tunnel at the wrist alongside nine tendons. When pressure in that tunnel rises the nerve stops working properly, and the first thing to go is sensation in the thumb, index and middle fingers.The BMJ Bland, 2007
It is the commonest nerve compression there is. The classic history is waking at night shaking the hand, and that single detail does more diagnostic work than any test.The BMJ Bland, 2007
Tingling and numbness in the thumb, index and middle fingers, worse at night and when holding a phone or a steering wheel. Pain can travel up the forearm. The little finger is supplied by a different nerve and is usually spared.The BMJ Bland, 2007
An underactive thyroid, diabetes, pregnancy, rheumatoid arthritis and previous wrist fracture all raise the risk. Thyroid and HbA1c are worth checking in anybody presenting with it, because treating the cause changes the outlook.NICE NG145, 2019
Diabetes both causes and worsens it, and blood sugar is checked in anyone with symptoms in both hands or a poor response to treatment.NICE NG28, 2022
Send us what you are seeing and we will tell you what it is likely to be.
The diagnosis is usually clinical. The history of night waking, the distribution of numbness, tapping over the nerve and holding the wrist bent are what the examination covers, along with looking for wasting at the base of the thumb.The BMJ Bland, 2007
Nerve conduction studies are arranged where the diagnosis is uncertain, where surgery is being planned, or where another nerve problem is possible. They are not needed to justify a splint or an injection in a typical presentation.NICE NG127, 2023
A night splint
Holds the wrist straight while you sleep, which is when pressure in the tunnel peaks. It is the cheapest treatment, it helps a proportion of mild to moderate cases, and it is worth 6 to 8 weeks before it is judged.The BMJ Bland, 2007
Treating the underlying cause
Thyroid, blood sugar and inflammatory disease corrected where they are contributing. Symptoms during pregnancy usually settle after delivery.NICE NG145, 2019
A steroid injection
A single injection produces significantly greater symptom relief at one month than placebo. The benefit beyond a month is less clear and a proportion of people relapse, so it buys time and is not usually a permanent answer.Cochrane Database of Systematic Reviews Marshall, 2007
Surgical release
Surgery improves symptoms more than splinting at 3 months and beyond in a randomised comparison. It is a day case under local anaesthetic and it is the definitive treatment for moderate to severe compression.Cochrane Database of Systematic Reviews Verdugo, 2008
A night splint is given 6 to 8 weeks before it is judged. Where symptoms come and go and there is no weakness, that is a reasonable first step. Where numbness is constant or the thumb muscle is wasting, waiting costs nerve that does not fully recover.The BMJ Bland, 2007
The inconvenient half. Steroid injection gives clear relief at one month and the evidence for lasting benefit beyond that is weaker, so a proportion of people who improve will relapse and need surgery anyway. Being told that before the injection is the point.Cochrane Database of Systematic Reviews Marshall, 2007
Surgery outperforms splinting from 3 months onward, and it is an operation with a recovery and a scar. Which of those trades you want is your decision once both are set out.General Medical Council GMC guidance, 2020
Do the flick test. If you wake at night with a numb hand and shaking it out relieves the tingling, that history alone points strongly at carpal tunnel syndrome and does more than any examination finding.The BMJ Bland, 2007
Check which fingers. Thumb, index and middle is the median nerve. Numbness including the little finger is a different nerve and a different problem, and knowing which you have changes the appointment before it starts.The BMJ Bland, 2007
Buy a night splint and wear it for 2 weeks before you come. It costs less than the appointment, it helps a proportion of people on its own, and if it has already worked you have saved yourself the rest of the pathway.The BMJ Bland, 2007
Do not buy nerve conduction studies before you have been examined. They are for uncertain diagnoses and for planning surgery, and in a typical history with typical numbness they confirm what the examination already showed.NICE NG127, 2023
Do not buy an injection if the thumb muscle is already wasting. That is nerve damage rather than irritation, waiting delays the operation that is needed, and saying so costs us a procedure fee.Cochrane Database of Systematic Reviews Verdugo, 2008
Do not buy vitamin B6 supplements for this. The evidence does not support them and it is the most commonly recommended thing on the internet that does nothing.The BMJ Bland, 2007
Step 1
Which fingers, the night history, the examination, and a look for wasting at the base of the thumb.
Step 2
Thyroid and blood sugar in the same visit, a night splint fitted properly, and 6 to 8 weeks to judge it.
Step 3
Where numbness is constant or the muscle is wasting, a surgical opinion is arranged rather than another course of splinting.
Ask before you book if you are not sure this is the right appointment.
Tingling and numbness in the thumb, index and middle fingers, worst at night, often relieved by shaking the hand out. Pain can travel up the forearm. Numbness including the little finger is a different nerve and a different diagnosis.
They help a proportion of mild to moderate cases and they are the cheapest thing to try. Wear it for 6 to 8 weeks before judging it. Where numbness is already constant or the thumb muscle is wasting, splinting delays what is actually needed.
A single injection gives clearly greater relief than placebo at one month. The evidence for lasting benefit beyond that is weaker and a proportion of people relapse and go on to surgery anyway, which is worth knowing before you have one.
Not for a typical presentation. They are used where the diagnosis is uncertain, where another nerve problem is possible, or where surgery is being planned. In a classic history they confirm what the examination has already established.
For moderate to severe compression, yes. A randomised comparison found surgery improved symptoms more than splinting from 3 months onward. It is a day case under local anaesthetic with a recovery period and a small scar in the palm.
Because an underactive thyroid and diabetes both cause and worsen carpal tunnel syndrome, and treating the cause changes the outlook. The Core panel covering both is £350 and it is worth having in anyone presenting with this.
A 30 minute appointment with a full examination of the nerve is £150. The Core blood panel checking thyroid and blood sugar is £350. The review at 8 weeks by telephone is £59. Splints are bought from a pharmacy for a few pounds.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
Cochrane Database of Systematic Reviews
Local corticosteroid injection for carpal tunnel syndromeMarshall, 2007
Cochrane Database of Systematic Reviews
Surgical versus non surgical treatment for carpal tunnel syndromeVerdugo, 2008
General Medical Council
Decision making and consentGMC guidance, 2020
NICE
Thyroid disease, assessment and managementNG145, 2019
NICE
Type 2 diabetes in adults, managementNG28, 2022
NICE
Suspected neurological conditions, recognition and referralNG127, 2023
The BMJ
Carpal tunnel syndrome, clinical reviewBland, 2007
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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