Where numbness in the hand comes from
The carpal tunnel is a narrow space on the palm side of the wrist, through which the median nerve runs together with the finger flexor tendons. When the pressure in the tunnel rises – because of swelling, thickening of the tendon sheaths, or holding the wrist bent for long periods – the nerve’s blood supply gets worse and it starts to react with tingling and numbness. Typically this affects the thumb, the index and middle fingers and part of the ring finger, and spares the little finger.
At first the symptoms come and go: at night, in the morning, or when holding a phone or a steering wheel. Over time they can become constant, and that is a sign that the nerve is being compressed more strongly and you need to act faster.
Carpal tunnel syndrome is more common in women – including during pregnancy – in middle-aged people, and in people with diabetes or thyroid disease. It is not just an “IT workers’ disease”: computer work can make the symptoms worse, but the problem is more strongly linked to physical work with vibrating tools or with a repetitive, strong grip.
Diagnosis and ruling out other causes
The diagnosis is made on the basis of the history and clinical examination. We check which fingers go numb, what sensation is like, how strong the thumb muscles are, and whether provocation tests reproduce the symptoms. Just as important is what we look for beyond the wrist: numb fingers are often caused by irritation of a nerve root in the cervical spine, and sometimes both problems are present at once. If the examination points to the neck, we treat it as we would a cervical disc problem. Pain on the thumb side that gets worse with wrist movements, without numb fingers, on the other hand, more often points to De Quervain’s tenosynovitis.
When the picture is unclear, the symptoms are severe, or surgery is being considered, a doctor orders a nerve conduction study. Constant numbness, flattening of the muscles at the base of the thumb and a clearly weaker grip are reasons to see a doctor or a hand surgeon without delay – in that situation conservative treatment on its own may not be enough.
Conservative treatment
In mild and moderate cases the foundation is a night splint that keeps the wrist in a neutral position. Added to that are nerve and tendon glide exercises, which improve how they slide within the tunnel, and manual therapy of the tissues of the wrist and forearm. Do not expect an immediate effect – the nerve responds slowly, and improvement is usually assessed after a few weeks of consistent management.
Physiotherapy will not widen the carpal tunnel, but it can reduce the compression that comes from everyday positions and habits. That is why changes to how you work and sleep matter just as much as the exercises. Nerve glide exercises are done gently, without provoking strong tingling – if the symptoms get worse after them, we reduce the range and the number of repetitions rather than “forcing” the nerve.
Ergonomics and when to come in
A wrist bent back over the edge of the desk, a mouse placed too far away, a phone held in one hand for hours – these are small things that add up to many hours of compression a day. At the visit we discuss how your workstation is set up, and work out breaks and short exercises to do at your desk. If you have been waking at night with a numb hand for a few weeks, do not wait until the symptoms become constant – treatment started early gives the best results. You can arrange an appointment via the Contact page.