Waking at night with a numb hand is easy to dismiss. Perhaps you slept on it strangely. Perhaps you assume your circulation is poor. But when tingling keeps returning, particularly around the thumb, index and middle fingers, or gripping starts to feel weaker, carpal tunnel syndrome becomes one possible explanation. It is a nerve-compression problem rather than simply a tight wrist.

What happens in carpal tunnel syndrome?

The carpal tunnel is a narrow passage through the wrist. The median nerve travels through it along with several tendons. Carpal tunnel syndrome occurs when the median nerve becomes compressed within this space. Typical symptoms can include tingling, numbness, pain and weakness in the hand. Symptoms often develop gradually and can be worse at night. Some people shake their hands for temporary relief; others notice difficulty gripping a cup, using tools or completing fine hand tasks.

Is typing always the cause?

No. Repetitive or sustained wrist positions can aggravate symptoms in some people, but carpal tunnel syndrome should not automatically be reduced to 'you type too much'. Pregnancy, diabetes, arthritis, previous wrist injury and other factors can increase susceptibility. Not every tingling hand comes from the wrist either; nerves can be affected at different points in the arm or neck. Revive's office-worker physiotherapy guide is useful for understanding how workstation load can contribute to upper-limb symptoms without assuming one diagnosis.

How is carpal tunnel syndrome assessed?

A clinician will usually begin with the symptom pattern and physical examination. The 2024 American Academy of Orthopaedic Surgeons guideline notes that a structured clinical assessment such as CTS-6 can be used for diagnosis and that MRI or nerve testing is not necessary in every straightforward case. Tests may still be appropriate when the diagnosis is uncertain or when severity needs clarification. Persistent numbness should not be diagnosed from a single internet wrist test.

Where does physiotherapy fit?

Physiotherapy or hand therapy can contribute to conservative management by helping patients understand aggravating loads and maintain comfortable hand and wrist function. Depending on assessment findings, advice may include modifying sustained wrist positions, reviewing work or tool use and using carefully selected mobility or nerve-gliding exercises. Exercise should not be marketed as a guaranteed cure. The NHS notes that nighttime wrist splinting is one commonly used conservative option, while evidence for some exercises is limited.

Look beyond the painful area

Hand symptoms sometimes coexist with elbow, shoulder or neck overload. Revive's article on tennis elbow from everyday and computer use is a useful internal resource because it explains how wrist and forearm demands can build during ordinary tasks. A physiotherapist may also assess the neck and upper limb when the symptom pattern suggests a more proximal nerve source. Revive's physiotherapy services page outlines broader assessment and treatment options.

Why early attention can matter

Intermittent pins and needles are one thing; persistent sensory loss or progressive muscle weakness is another. If compression becomes significant, everyday hand function can be affected. Someone who increasingly drops objects, cannot grip normally or notices constant numbness should seek medical assessment rather than continuing to stretch and hope it settles.

When is surgery considered?

Carpal tunnel release creates more room for the median nerve. It may be considered when symptoms are significant, worsening or have not responded adequately to appropriate conservative management. The AAOS guideline reports that endoscopic and mini-open techniques can provide similar long-term outcomes. Whether surgery is appropriate is an individual decision between the patient and the relevant specialist.

The practical takeaway

Carpal tunnel syndrome is a nerve-compression problem, and good care starts with establishing whether the median nerve at the wrist is actually the source. Physiotherapy can contribute to conservative management and functional recovery, but progressive weakness, persistent numbness or significant loss of hand function should prompt medical assessment.

Related Revive resources

• Office Worker Physiotherapy Guide

• Tennis Elbow Without Playing Tennis

• Physiotherapy Services

Sources

• NHS - Carpal tunnel syndrome

• American Academy of Orthopaedic Surgeons - 2024 Carpal Tunnel Syndrome Guideline Update

Medical disclaimer: This article is for general informational and educational purposes only. It does not provide a diagnosis or personalised treatment plan and does not replace advice, examination or treatment from a qualified doctor, physiotherapist or other healthcare professional. Seek appropriate medical attention for severe, rapidly worsening, traumatic, neurological or otherwise concerning symptoms.