Clinical Features

Symptoms usually start gradually with aching, tingling, burning, itching, pins and needles, numbness and sometimes pain in the area of the hand supplied by the median nerve.

This area covers the thumb, index and middle fingers, and part of the ring finger, also most of the palm of the hand. Some individuals report that their fingers feel useless and swollen even though little or no swelling is apparent. In time, symptoms can also spread to the arm and shoulder.

The symptoms often first appear during the night or first thing in the morning. This is because many people sleep with flexed or bent wrists, and this position makes the symptoms worse by putting extra pressure on the already compressed nerve. A person with carpal tunnel syndrome may wake up feeling the need to shake the wrists or hang their arm out of bed in order to obtain some relief of symptoms.

The dominant hand is normally first affected but carpal tunnel syndrome can affect both hands. As the condition worsens, the symptoms which initially may have been mild and intermittent tend to become constant and persist during the day. The hand muscles also become weakened as the condition progresses, and in severe cases those at the base of the thumb may waste away with resultant decreased grip strength and manual dexterity. There may be permanent loss of feeling in the palm of the hand, the thumb and the index, middle and part of the ring fingers on the palm side. Fine finger movements, such as writing, may become more difficult. Some people are unable to distinguish between hot and cold by touch.