Also called: Median nerve compression; numb hands at night
Exercise strongly helps
Stretch
Massage
Strength
Numb, tingling hands that wake you at night and are shaken out to relieve them. The median nerve is compressed in a tunnel at the wrist, and the two things that raise the pressure most are a bent wrist and sustained gripping.
How common: 2.7-5.8% of the general adult population
What it is
The carpal tunnel is a rigid space at the front of the wrist through which nine tendons and the median nerve pass. Anything that raises the pressure inside it compresses the nerve, which supplies sensation to the thumb, index, middle and half the ring finger, and power to the thumb muscles.
The night symptoms are the giveaway. Most people sleep with the wrists flexed, which raises tunnel pressure substantially, and fluid redistributes when lying down. That is why the classic story is waking at two in the morning shaking the hand - and it is a more useful diagnostic clue than anything felt during the day.
What it feels like
- Numbness and tingling in the thumb, index, middle and half the ring finger
- Worst at night, waking you, and relieved by shaking or hanging the hand down
- Worse holding a phone, a book, a steering wheel or a hairdryer
- Dropping things, and difficulty with buttons and small objects
- Later, wasting of the muscle bulk at the base of the thumb
What causes it
Most people have more than one of these at once, and they feed each other. Read the
list looking for the two or three that sound like your week rather than for the one
true answer — the ones that describe you are the ones worth acting on.
- Raised pressure inside a rigid tunnel
- The tunnel cannot expand. Any increase in the volume of its contents, or any position that reduces its size, compresses the nerve directly.
- Sustained wrist flexion or extension
- Pressure in the tunnel rises steeply as the wrist moves away from neutral. Sleeping with a bent wrist and working with an extended one are the two commonest positional drivers.
- Repetitive gripping and force
- Forceful, repetitive hand use raises pressure through tendon movement and swelling. Vibrating tools are particularly strongly associated.
- Pregnancy
- Fluid retention raises tunnel pressure, and carpal tunnel symptoms are very common in the third trimester. They usually resolve after delivery, which is worth knowing before considering surgery.
- Underactive thyroid
- Hypothyroidism causes soft tissue swelling including within the tunnel. It is an easily tested and easily corrected secondary cause.
- Diabetes
- Substantially raises the risk, both through nerve vulnerability and through connective tissue changes. Carpal tunnel syndrome is often the first nerve problem someone with diabetes notices.
- Rheumatoid and inflammatory arthritis
- Synovial swelling around the tendons inside the tunnel directly reduces the space available.
- Obesity
- A consistent and independent risk factor, probably through increased fatty tissue within the tunnel and generalised fluid handling.
- Anatomy
- Tunnel size varies between people, and a naturally small one raises susceptibility. It is part of why symptoms are often bilateral - the anatomy is the same on both sides.
- Neck nerve root problems - the imitator
- A compressed cervical nerve root can produce hand numbness in a similar distribution. Symptoms following a whole-limb pattern, or accompanied by neck pain, deserve that consideration.
Who tends to get it
- Anyone doing repetitive forceful hand work, especially with vibrating tools
- Pregnant women, particularly in the third trimester
- People with diabetes, hypothyroidism or inflammatory arthritis
- Women, in whom it is two to three times more common
- Anyone with a family history, reflecting inherited tunnel size
What makes it worse, and what settles it
Makes it worse
- Sleeping with the wrist bent, which is the single biggest overnight factor
- Sustained gripping and vibrating tools
- Working with the wrist extended at a keyboard or mouse
- Ignoring progressive numbness or thumb weakness, which indicates nerve damage rather than irritation
- Untreated thyroid disease, which will keep it coming back
Settles it
- A neutral wrist splint worn at night, which is the single most effective conservative measure
- Nerve and tendon gliding exercises, which have reasonable evidence
- Changing the workstation so the wrist stays near neutral
- Massage and soft tissue work on the forearm flexors
- Getting thyroid function checked where symptoms are bilateral or unexplained
What actually helps
The short version: Raised pressure in the carpal tunnel compressing the median nerve; worse with sustained wrist flexion or extension
Strength work: Arms: Forearms: Wrist Flexors; Wrist Extensors; Hands, Fingers, Forearms, Grip - build tolerance, do not aggravate
Stretching: Hands, Fingers, Wrists
Massage: Arms: Forearms; Hands, Fingers
Also worth doing: Night wrist splint in neutral is first-line; median nerve and tendon gliding; keyboard and mouse setup
What the evidence says: Splinting has the best evidence; nerve and tendon gliding is a reasonable low-cost adjunct. Do not promise resolution of established denervation.
The names above are the Targets qFIT tracks —
the Muscle Guide explains what each one does, and
Quick Add switches on the Exercises you
already have.
The qFIT routine for this
Ready-made routineWrist, Hand & Thumb Relief
qFIT already has this one built. It runs massage first, then stretching, then
strength — the order that works on a body that is already sore — and every
activity in it carries the reason it is there.
The button below opens your Checklist with this routine already selected, so instead
of your whole list you land on just its Categories, Targets
and Exercises, each with its checkbox, ready to tick as you work through
them.
Have more than one problem? Tick yours under My Problems on
My Profile and your Checklist's Routine list gains
Recommended for my problems — every routine for the problems you picked, merged
into one. Your picks stay private; that filter is the only thing they feed.
Get it checked if…
Constant numbness, thenar wasting or weakness means it is advanced - surgical referral, do not delay with exercises
And whatever the body part: chest pain or unusual breathlessness on
exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and
unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or
one calf that is swollen, warm and painful. Any of those, stop and get assessed.
How it usually goes
Night splinting plus nerve glides resolves or substantially improves mild to moderate symptoms in a large proportion of people over six to twelve weeks. Pregnancy-related cases usually resolve after delivery. Constant numbness, or visible wasting of the thumb muscle, indicates established nerve damage where surgery is more likely to be needed and where delay costs recovery - so that presentation should be assessed promptly rather than managed with a splint.
Prevalence basis: Population nerve-conduction studies
Others the same routine covers
These share the Wrist, Hand & Thumb Relief routine, so the work is the same. If one of them also
sounds like you, that is a reason to expect more from it, not less.
This is general information, not a diagnosis, and it cannot examine you.
If it matches you, use it to ask better questions of a clinician rather than to replace one.