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Record in brite when your fingers go numb, document your splint and medication and arrive at your appointment with a clear overview. Free of charge.
Persistent numbness or visible muscle wasting at the base of the thumb are warning signs of lasting nerve damage — in that case do not wait, but have it assessed promptly by a specialist.
In carpal tunnel syndrome (CTS), an important nerve of the hand — the median nerve (nervus medianus) — is placed under pressure at the narrow point in the wrist. This narrow point is the carpal tunnel: a short, tight channel between the carpal bones and a firm ligament. If the space inside becomes tight, the nerve comes under pressure, and this is exactly what causes the typical symptoms — tingling, numbness and pain in the hand.
Carpal tunnel syndrome is the most common nerve compression disorder of all. Those affected are above all women of middle and older age, but also pregnant women, people with certain metabolic disorders and those who put a great deal of strain on their hands. The tricky part: the symptoms often begin gradually and are not taken seriously at first — almost everyone knows the feeling of a hand "falling asleep" at night. With CTS, however, this feeling keeps coming back and grows stronger over time.
Why is a permanently compressed nerve a problem? A nerve depends on a good blood supply to reliably transmit signals. If it is under pressure for a long time, the fine blood supply is disturbed first — hence the tingling and numbness. If the pressure persists, the protective sheath of the nerve can take damage, and eventually the nerve fibres themselves suffer too. In this way, what was initially only an unpleasant tingling can turn into lasting numbness or a weakness of the hand muscles. That is why it is worth taking CTS seriously early on: treated in good time, the prognosis is very good.
To understand why certain fingers of all things are affected, a brief look at the anatomy helps. The carpal tunnel lies on the flexor side of the wrist — that is, on the inner side, where you feel the pulse. The floor and side walls are formed by the carpal bones, the roof by a taut, unyielding ligament (the flexor retinaculum).
Several structures pass through this narrow tunnel: the flexor tendons of the fingers and — crucially — the median nerve. The nerve has the least room here and is the most sensitive "co-tenant". If something inside the tunnel swells, for example the tendon sheaths from overuse or the tissue from fluid retention, the pressure rises — and because the roof cannot give way, it is the nerve that is affected first.
The median nerve supplies sensation to a very specific area of the hand: the thumb, the index finger, the middle finger and the half of the ring finger facing the thumb. This is exactly why it is these fingers that tingle and go numb with CTS — the little finger is typically spared, because it is supplied by a different nerve. This difference is an important distinguishing feature and helps to tell CTS apart from other causes.
By far the most important sign is fingers going numb and tingling at night. Many of those affected wake up at night because the hand is "numb" or "furry", and have to shake it out to get the feeling back — this characteristic shaking even has its own name: the flick sign. There is a simple reason why the symptoms occur particularly at night: during sleep, many people unconsciously bend the wrist, which further increases the pressure in the tunnel.
Typically, the symptoms develop in this order:
Important to know: not everyone goes through all stages, and the symptoms can remain stable for months or even improve for a time. Muscle wasting at the base of the thumb and persistent numbness are, however, alarm signs — they indicate that the nerve has already been damaged for a longer time and more severely, and should be assessed promptly by a specialist.
In many cases no single cause can be identified — in some people the tunnel is naturally narrower, and the tissue changes with age. Frequently, however, several factors come together that increase the pressure in the carpal tunnel. The most important ones:¹
Because a treatable underlying condition sometimes lies behind CTS, a targeted assessment is worthwhile — especially if both hands are suddenly affected, the symptoms increase very rapidly or additional symptoms are present. If, for example, an underactive thyroid is identified and treated, the nerve symptoms can improve as a result alone.
Diagnosis begins with the conversation: the typical night-time numbness of the right fingers is already a strong clue. The doctor then checks the sensation and strength of the hand and uses two simple provocation tests, which you can get to know yourself too — but they do not replace a medical examination.¹,²
Sometimes CTS has to be distinguished from other causes, such as nerve compression at the elbow, a slipped disc in the cervical spine or a polyneuropathy. A good indicator remains the distribution pattern: if specifically the thumb, index and middle finger are affected and the hand goes numb mainly at night, CTS is the most likely explanation.
As long as there is no permanent nerve damage yet, carpal tunnel syndrome is initially treated without surgery. The most important building block is the night-time wrist splint. It holds the wrist in a neutral, straight position and prevents the unconscious bending during sleep — exactly the position that drives up the pressure in the tunnel. Many already feel a clear improvement in their night-time symptoms after just a few weeks.¹
The splint works best with mild to moderate CTS and when the symptoms have not been present for long. Patience and consistency are important: the splint should be worn every night over several weeks. Depending on the cause, further measures help alongside it.
Medication also plays a supporting role. Anti-inflammatory painkillers such as Ibuprofen can help against pain in the short term but do not fix the narrowing itself. The cortisone preparation Prednisolone has a special place: injected specifically into the carpal tunnel, it can noticeably reduce the swelling temporarily and improve symptoms for a few weeks to months — making it also a good test of whether relieving the nerve helps at all. With radiating, burning nerve pain, a nerve-pain medication such as Pregabalin is occasionally considered. Important: with progressive damage, none of these medications replaces the actual treatment.
If conservative treatment does not help sufficiently, if muscle wasting or persistent numbness is already present, or if the nerve measurement shows clear damage, surgery is the treatment of choice. The principle is simple and effective: the taut ligament that forms the roof of the carpal tunnel is cut through. This enlarges the tunnel, and the pressure on the nerve eases immediately — this is referred to as releasing the retinaculum.¹,²
The procedure is one of the most common and most reliable in hand surgery. It is usually performed as a day case and under local anaesthesia — the hand is numbed, you are awake and can go home the same day. There are two established techniques:
After surgery, the hand is usually quickly usable again. The night-time numbness often disappears in the first nights — for many the most noticeable relief. A loss of sensation or muscle wasting that has already set in, by contrast, recovers only slowly and not always completely, which is why an early procedure has the better outlook. The stitches are removed after about two weeks; a certain tenderness in the area of the scar can persist for a few weeks to months.
Whether it is the splint, medication or aftercare following surgery — brite helps you keep track and forget nothing.
One of the most common questions is: is the splint enough, or do I need surgery? The honest answer depends on the stage. With mild CTS, a consistently worn splint improves the symptoms in a large proportion of those affected — however, the symptoms often return after stopping. With moderate to severe CTS, surgery is superior to the splint and leads to lasting freedom from symptoms in the great majority.¹
| Criterion | Night-time splint | Surgery |
|---|---|---|
| Suitable for | Mild to moderate CTS, pregnancy | Moderate/severe CTS, muscle wasting, failure of the splint |
| Prospect of success | Often good improvement, relapses after stopping common | Very high, mostly lasting success rate |
| Onset of effect | After a few weeks | Night-time numbness often gone immediately |
| Recovery time | None — wearable in everyday life | Light activities after days, full load after a few weeks |
| Risks | Hardly any, apart from relapse | Low: scar pain, rarely a wound-healing problem |
On the recovery time after surgery, in plain terms: the hand may be moved from the start, but heavy strain and firm gripping should be avoided for a few weeks. Those who work in an office are often fit for work again after one to two weeks; with physically heavy work involving strong exertion it can be four to six weeks or more. The exact duration depends on the technique, the occupation and the individual healing process and is determined together with the treatment team.
Important for the decision: surgery is not a "last resort", but with advanced CTS the more effective way to prevent lasting nerve damage. Conversely, not every mild CTS needs to be operated on immediately. The choice is made together — on the basis of the symptoms, the nerve findings and the personal situation.
Record in brite how your symptoms develop with the splint or after surgery — ideal for your next doctor's appointment.
Whether with a splint, after surgery or in the observation phase — in everyday life there is a lot you can do yourself to relieve your hands:
Carpal tunnel syndrome often accompanies you over weeks and months — with a splint, medication, follow-up appointments and sometimes surgery including aftercare. brite helps you keep track and carry out your treatment consistently.
