Carpal Tunnel Syndrome (CTS) is a common condition affecting the hand and wrist, stemming from increased pressure on the median nerve. The nerve is compressed as it passes through the carpal tunnel, a narrow passageway formed by wrist bones and the transverse carpal ligament. Compression within this confined space disrupts the nerve’s function, leading to a distinct set of symptoms primarily felt in the hand.
Common Carpal Tunnel Symptoms
The standard presentation of Carpal Tunnel Syndrome involves numbness, tingling, or a burning sensation in the thumb, index finger, middle finger, and the thumb-side half of the ring finger. The little finger is spared because its sensation is controlled by the ulnar nerve.
These sensations often feel like “pins and needles” and can occur intermittently. Symptoms are frequently worse at night, sometimes waking individuals from sleep. Repetitive activities involving prolonged wrist flexion or extension, such as driving or holding a phone, frequently trigger or worsen the tingling and numbness. As the condition progresses, a weakened grip and difficulty with fine motor skills, such as buttoning a shirt, can develop due to impaired nerve signaling.
How Carpal Tunnel Pain Radiates Upward
Pain and tingling from carpal tunnel syndrome can travel upward (proximally) from the wrist into the forearm, and sometimes as far as the elbow or shoulder. The median nerve originates from nerve roots in the neck and travels down the entire length of the arm. When the nerve is compressed at the wrist, the resulting pain signal can be referred backward along the nerve’s pathway.
This proximal radiation is a recognized feature of CTS. The compression at the wrist creates an electrical disturbance that the brain can interpret as coming from any point along the nerve’s course. If the median nerve is already irritated higher in the arm or neck, it becomes more susceptible to compression at the wrist. When the nerve is compromised in two places along its path, the symptoms can be more pronounced and extend further up the arm.
Other Conditions That Mimic Carpal Tunnel
Symptoms that extend significantly past the elbow or involve the little finger often point toward a different underlying cause. A condition known as cervical radiculopathy, or a pinched nerve in the neck, frequently mimics carpal tunnel syndrome. This occurs when a nerve root exiting the spinal cord is compressed, often due to a herniated disc or arthritic changes in the vertebrae. Since the nerves that form the median nerve originate here, this neck issue can cause tingling, numbness, and pain that radiates down the entire arm into the hand.
Another condition is Cubital Tunnel Syndrome, which involves compression of the ulnar nerve, typically at the elbow. This causes a distinct pattern of symptoms that includes tingling and numbness in the little finger and the adjacent half of the ring finger, completely sparing the thumb, index, and middle fingers. The location of the symptoms is the clearest way to differentiate between these nerve entrapments. If symptoms are persistent or affect the little finger, a medical evaluation is important to determine the correct nerve that is being compressed.
Diagnosis and Treatment
Diagnosis of Carpal Tunnel Syndrome begins with a physical examination and patient history. Physicians use specific provocative tests, such as Tinel’s sign, which involves lightly tapping over the median nerve at the wrist to check for tingling in the fingers. Another common test is Phalen’s maneuver, where the patient holds their wrist in a flexed position for about a minute to reproduce the numbness and tingling.
To confirm the diagnosis and determine the severity of compression, electrodiagnostic studies are often performed. These include nerve conduction studies (NCS), which measure the speed of electrical signals through the median nerve at the wrist. Initial treatment for mild to moderate cases focuses on non-surgical methods, such as wearing a wrist splint, especially at night, and using nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid injections can also reduce inflammation and swelling, providing temporary relief. If non-surgical treatments fail or nerve compression is severe, carpal tunnel release surgery may be recommended to cut the transverse carpal ligament and relieve pressure on the median nerve.