What carpal tunnel syndrome is
The median nerve travels from your forearm into your hand through a narrow passage at the wrist — the carpal tunnel. When that space gets crowded (swelling, repetitive use, pregnancy, thyroid disease, diabetes, or inflammatory arthritis), the nerve gets pinched.
The classic pattern: numbness, tingling, or burning in the thumb, index, middle, and half of the ring finger — often worst at night, often waking you up, often making you shake the hand to get feeling back. As it progresses, grip weakens and fine tasks (buttons, keys, jars) get harder.
Most carpal tunnel syndrome can be managed without surgery, especially if you start early. The stepwise approach below is what works for the majority of patients.
Step 1: A wrist brace, worn at night
This is the first thing we try. It’s also the step patients most often do wrong.
Why night-only
During sleep, the wrist naturally curls. Bending the wrist in either direction sharply raises pressure inside the carpal tunnel and squeezes the median nerve further — which is why symptoms so often wake people up. A brace holds the wrist straight (neutral) through the night so the nerve gets a chance to calm down.
Night-only wear works as well as all-day wear, and people actually stick with it. In studies, 85–100% of patients are compliant with night-only bracing. Only about 27% manage all-day wear.
What to buy
- Spend no more than $15 per wrist. A $70 “premium” brace does not work better than a $12 one
- Avoid braces covered in velcro — more straps means more hassle and more chance you’ll give up
- Avoid combo splints that immobilize the thumb or fingers — you want the wrist held straight, not your whole hand immobilized
- Pick a simple soft brace with one firm stay along the palm side — that’s the piece doing the work
- Two wrists = two braces. Don’t alternate
Search for “night wrist splint” or “cock-up wrist splint” at any pharmacy or online retailer. If two options are in front of you and one is $12 and one is $40, buy the $12.
How to wear it
- At night only, every night
- Snug but not tight — you should be able to slide a finger under the strap
- Wear it on both wrists if both hands are symptomatic
- If you wake up with the hand still numb, shake it out and go back to sleep
Give it 30 days
Wear the brace every night for 30 days before deciding whether it’s working. A few nights is not a fair trial. Improvement is usually gradual: fewer wake-ups, less morning numbness, milder daytime tingling.
At 30 days:
- Clear improvement — keep going. Many patients stay on night splinting indefinitely with good results
- Partial improvement — keep the brace and consider the next step
- No change — time to talk about an injection
Step 2: A corticosteroid injection
If splinting alone doesn’t settle symptoms — or if they’re more than a nighttime nuisance — the next step is a corticosteroid injection into the carpal tunnel.
What it is
A small amount of steroid is injected into the carpal tunnel to reduce swelling around the median nerve. We use ultrasound guidance to place the needle precisely alongside the nerve (never into it), which is safer and more accurate than doing it by feel. The injection itself takes a few minutes and is usually less uncomfortable than patients expect.
What to expect
- Most patients who respond feel better within 2 to 4 weeks
- Relief typically lasts up to 6 months, sometimes longer, sometimes less
- A good response also supports the diagnosis and predicts a good outcome from surgery if surgery becomes necessary
An injection is not a long-term fix. Roughly 40% of patients who get one go on to carpal tunnel release within a couple of years — not because the injection failed, but because the underlying anatomy eventually wins. Think of it as a reset button, not a cure.
Step 3: Carpal tunnel release surgery
If symptoms return after an injection, grip is weakening, you’re dropping things, or nerve studies show significant damage, it’s time to consider carpal tunnel release. This is performed by a hand surgeon — we’ll arrange the referral.
The basics
- Outpatient — home the same day, usually within an hour or two
- Local anesthesia or light sedation — not general in most cases
- The procedure — a small incision at the base of the palm (open) or one or two tiny incisions at the wrist (endoscopic). The surgeon cuts the tight ligament that forms the roof of the carpal tunnel, releasing pressure on the nerve
- About 15 minutes of surgical time
Recovery
- Daily activities (eating, dressing, light tasks) within a few days
- Stitches out around 10–14 days
- Palm and scar soreness for a few weeks — up to 2 months with open, often closer to 2 weeks with endoscopic
- Strenuous use, gripping, heavy lifting — usually cleared at 4 to 6 weeks
- Nighttime symptoms often improve almost immediately; daytime numbness fades more gradually; long-standing numbness or weakness may only partially recover
Open vs. endoscopic: both work. Endoscopic offers slightly faster return to work and less short-term scar tenderness. Long-term outcomes are essentially the same — your hand surgeon will recommend the approach that fits your anatomy.
Frequently asked questions
Can I wear the brace during the day too? You can, but it’s rarely necessary and compliance drops off quickly. Night-only wear is where the benefit is.
Do I need nerve conduction studies (EMG) before treatment? Not for Step 1 or Step 2. We usually order EMG if symptoms persist despite splinting and injection, or to document severity before surgery.
Will pregnancy-related carpal tunnel go away? Usually, yes — most pregnancy-related cases resolve within a few months after delivery. Night splinting is the mainstay during pregnancy.
Can the injection damage my nerve? With ultrasound guidance, the risk is very low. The needle is placed alongside the nerve, not into it, and visualized in real time.
How many injections can I have? We generally limit a given wrist to two or three injections in a year. If you need more than that, surgery is usually the better answer.
When to call us
- Numbness that is constant rather than intermittent
- Noticeable weakness — dropping things, trouble with buttons or keys
- Visible wasting of the muscle at the base of the thumb
- Symptoms that wake you multiple times a night despite a month of proper brace use
- New symptoms after injection or surgery that seem out of proportion
This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.