What are the symptoms of carpal tunnel syndrome (CTS)?

From the Guidelines

Carpal tunnel syndrome is typically characterized by symptoms of numbness, tingling, and pain in the hand and fingers, particularly affecting the thumb, index, middle, and half of the ring finger, which can be diagnosed by clinical evaluation combined with electrophysiologic studies, and in selected circumstances, either wrist US or MRI without contrast may be appropriate for further evaluation 1. The symptoms of carpal tunnel syndrome often worsen at night or during activities that involve wrist flexion, such as driving or holding a phone. Many patients report having to shake their hands for relief, known as the "flick sign." As the condition progresses, weakness in the thumb muscles may develop, making it difficult to grip objects or perform fine motor tasks. Some people experience pain that radiates up the arm to the shoulder. Key points to consider in the diagnosis of carpal tunnel syndrome include:

• Clinical evaluation and electrophysiologic studies as the primary diagnostic tools 1
• The use of wrist US as a highly sensitive and specific diagnostic tool, particularly for identifying space-occupying lesions, anatomic variants, and tendon pathology in the carpal tunnel 1
• The importance of early recognition and treatment to prevent permanent nerve damage
• The potential for symptoms to start gradually and affect one or both hands, though often beginning in the dominant hand
• The underlying cause of compression of the median nerve as it passes through the carpal tunnel in the wrist, commonly due to repetitive hand movements, pregnancy, diabetes, rheumatoid arthritis, or thyroid disorders. The most recent and highest quality study, published in 2024, supports the use of US as a confirmatory test of choice or as a complementary test for the suspected diagnosis of CTS, due to its ability to identify space-occupying lesions, anatomic variants, and tendon pathology in the carpal tunnel 1.

From the Research

Symptoms of Carpal Tunnel Syndrome

• Carpal tunnel syndrome (CTS) is caused by compression of the median nerve as it travels through the carpal tunnel, resulting in symptoms such as pain, paresthesia, and weakness in the distribution of the median nerve 2.
• Patients with CTS typically experience paresthesia, pain, and numbness in the radial three and one-half digits, with nighttime symptoms being more common earlier in the disease process 3.
• The symptoms of CTS are related to compression of the median nerve, which results in pain, numbness, and tingling 4.
• CTS can also result in muscle wasting, diminished sensitivity, and loss of dexterity 5.

Common Symptoms

• Pain in the wrist and hand
• Numbness and tingling in the thumb, index, and middle fingers
• Weakness in the hand and wrist
• Nighttime symptoms, such as waking up with numbness or tingling in the hand
• Muscle wasting and diminished sensitivity in the hand 2, 3, 4, 5

Diagnosis and Treatment

• The diagnosis of CTS is typically made based on a combination of physical examination findings, medical history, and electrodiagnostic studies 2, 3, 4.
• Treatment options for CTS include lifestyle modifications, splinting, corticosteroid injections, and surgery 2, 3, 4, 6.
• Splinting, including night-time splinting, may provide some benefits in symptoms and hand function, although the evidence is not conclusive 5, 6.