Carpal Tunnel Syndrome: The Pinched Nerve in the Wrist

The carpal tunnel is a narrow passageway on the inner side of the wrist. The median nerve and several flexor tendons of the fingers pass through it. Normally, this tunnel provides sufficient space. However, if the surrounding tissue swells or the tunnel narrows, pressure on the nerve increases.

As a result, nerve impulses are no longer transmitted properly. Initially, this causes tingling or numbness; later, pain and loss of strength may develop. If the pressure persists over a long period, the nerve can be permanently damaged. 

It is not always possible to identify a single, clear cause. Often, several factors play a role at the same time.

The most common risk factors include:

• Repetitive strain on the hand
• pregnancy
• Diabetes mellitus
• Thyroid disorders
• rheumatic diseases
• Obesity
• Wrist injuries
• Genetic predisposition

Women are affected significantly more often than men. Carpal tunnel syndrome occurs more frequently, particularly between the ages of 40 and 70. 

Many people with the condition initially notice the symptoms only at night. They wake up because their fingers tingle, go numb, or hurt. At first, it often helps to shake out the hand or change its position.

As the condition progresses, the symptoms increasingly occur during the day as well. Even everyday activities such as writing, talking on the phone, or holding a book can become uncomfortable.

Typical symptoms include:

• Tingling in the thumb, index finger, and middle finger
• Numbness
• Nighttime pain
• Burning sensation in the hand
• Fingers that have gone numb
• Decreased grip strength
• Difficulty holding small objects

In advanced stages, the muscles at the base of the thumb may atrophy. This makes simple movements increasingly difficult. 

Numbness or pain in the hand can have various causes. Conditions affecting the cervical spine, nerve damage, or circulatory disorders can also cause similar symptoms.

Therefore, carpal tunnel syndrome should not be self-diagnosed. A medical examination helps rule out other conditions and initiate the appropriate treatment. 

Even the description of the symptoms provides important clues. The doctor then examines the range of motion, sensation in the fingers, and muscle strength of the hand. In addition, special functional tests are used, in which the wrist is moved into specific positions or gently tapped. If these maneuvers trigger the typical symptoms, this suggests carpal tunnel syndrome.

To confirm the diagnosis, nerve conduction velocity is often measured. This helps determine the extent to which the median nerve is already impaired. 

The appropriate treatment depends on the severity of the symptoms and whether nerve damage has already occurred. In the early stages, a wrist splint—worn especially at night—is often sufficient. It holds the wrist in a favorable position and relieves pressure on the nerve. In addition, anti-inflammatory medications or, in certain cases, cortisone injections may be used.

If the symptoms are already more severe or there is significant compression of the nerve, surgery is often recommended. During the procedure, the ligament that forms the wall of the carpal tunnel is cut. This creates more space for the nerve and relieves the pressure. 

There are also some measures you can take in your daily life to relieve pressure on the wrist and prevent symptoms.

The following are helpful, among other things:

• Avoiding one-sided strain as much as possible
• taking regular breaks when working at a computer
• using ergonomic workstations
• Keep your wrists as straight as possible
• Consistently wear prescribed splints
• Perform the exercises prescribed by your physical therapist

Responding to the first signs of discomfort early on can often prevent symptoms from worsening. 

Carpal tunnel syndrome usually develops gradually and often begins with seemingly harmless symptoms such as nighttime tingling or numb fingers. If the pinched nerve is treated in time, pain, numbness, and loss of strength can be significantly improved in many cases. This helps the hand maintain its mobility and function in the long term.