Carpal Tunnel Syndrome

Symptoms and red flags

Most patients describe the same pattern. The fingers go to sleep at night, often in the early hours, and the patient wakes and shakes the hand or hangs it over the edge of the bed until the feeling returns. During the day the tingling comes back while holding a phone, a steering wheel, a rolling pin or a motorbike handle. The ache can travel up the forearm.

As the months pass the signs change. Objects start slipping from the hand, and a cup or a key falls without warning. The numbness stops coming and going and becomes constant. In long-standing cases the muscle at the base of the thumb flattens and the thumb loses its strength to pinch. These later signs mean the nerve is already damaged, and they are the red flags that should bring a patient to a neurosurgeon without delay.

Causes and who gets it

Anything that makes the tunnel tighter or the tendons thicker can bring it on. Repetitive hand work is the most common reason: sewing and embroidery, the kneading of dough, hand-washing of clothes, long hours at a keyboard, tools that vibrate, or a long daily motorbike ride. Women are affected more often than men, usually in middle age.

Pregnancy is another frequent cause because the body holds more fluid and the swelling presses on the nerve; this form usually settles after delivery and rarely needs an operation. Diabetes and an underactive thyroid both make nerves more vulnerable, and people with these conditions often develop the problem in both hands. An old wrist fracture and rheumatoid arthritis are other known causes, and being overweight adds to the risk. Sometimes no cause is found at all.

How it is diagnosed

Diagnosis starts with the history and a careful examination of the hand. Dr. Salman Falak checks which fingers have lost feeling and tests the strength of the thumb muscles, then taps over the nerve at the wrist to see whether it sets off the tingling.

A nerve conduction study, or NCS, confirms it and shows how badly the nerve is affected. Small electrodes on the skin measure how fast the signal crosses the wrist, and a slow signal means the nerve is being squeezed. The test grades the problem from mild to severe, which guides the choice of treatment, and it rules out other causes. Numbness in the hand can also come from a pinched nerve in the neck or from diabetes affecting many nerves at once. An MRI of the wrist is rarely needed, though an MRI of the neck is sometimes ordered when the story does not fit a wrist problem alone.

Treatment: splints and injections first, then surgery

Mild and early cases are treated without an operation. A wrist splint worn at night keeps the wrist straight, the position in which the tunnel is widest, and many patients sleep through the night again within a few weeks. Controlling blood sugar or thyroid levels helps when those are part of the cause.

If the splint is not enough, a steroid injection into the carpal tunnel reduces the swelling around the nerve. Relief is often quick but may wear off after some months, and repeated injections are not a long-term answer. A good response to the injection also confirms that the wrist really is the source of the trouble.

Surgery is advised when symptoms are severe, when numbness has become constant, when the thumb muscles are wasting, or when a splint and an injection have been tried without lasting relief. Carpal tunnel release is a small operation that divides the tight band forming the roof of the tunnel so the nerve has room again. Dr. Salman Falak performs it under local anaesthesia in most cases, through a short cut in the palm, and the patient goes home the same day. The operation is described step by step on the carpal tunnel surgery page.

What recovery looks like

After the release the night tingling usually settles quickly, often within the first days, because the nerve is no longer squeezed. The wound is kept dry for about two weeks until the stitches come out, and the palm stays tender for a few weeks, so heavy gripping and lifting wait until it has healed. Light use of the fingers is encouraged from the first day.

Grip strength and any constant numbness take longer. A nerve that has been compressed for a year or more recovers slowly, over months, and in the most advanced cases some numbness or thumb weakness may remain even after a good operation. That is the honest reason Dr. Salman Falak recommends surgery before the muscle wasting sets in.

When to see a neurosurgeon

See a specialist if tingling wakes you at night more than occasionally, if numbness has lasted more than a few weeks despite resting the hand, if you have started dropping things, or if both hands are now affected. Constant numbness or a flattened thumb base is a reason to come in soon, because the window for full recovery narrows with time.

Patients outside Lahore do not need to travel for the first conversation. An online video consultation lets Dr. Salman Falak hear the story and look at the hand on camera, then advise which test to get locally. Many patients arrive in Lahore with the nerve conduction report already done, and the decision about treatment is then made in a single visit.

Related procedures and pages

The operation for this condition is carpal tunnel release, linked above. Numbness that starts in the neck and runs down the whole arm usually comes from a disc in the neck instead of the wrist, and that is a different problem with its own page. Patients coming from Faisalabad, Gujranwala, Sheikhupura and other cities can read how a visit is arranged on the page for patients from across Punjab. Dr. Salman Falak also holds an OPD in Gujranwala on Fridays and in Phool Nagar on Tuesdays, where the hand can be examined before any trip to Lahore.