Carpal Tunnel Syndrome: Why Your Hand Goes Numb at Night (and What to Do About It)
Waking up at 2am shaking out a numb hand? Finding yourself dropping things because your grip
suddenly feels weak? These are common symptoms people experience before they're diagnosed
with carpal tunnel syndrome.
If you're experiencing numbness and tingling in your fingertips and thumb, particularly at night,
carpal tunnel syndrome could be one possible cause. Here's what's happening, how it can be
treated, and how a hand therapist can help.
What is carpal tunnel syndrome?
The carpal tunnel is a narrow passageway on the palm side of your wrist. Its base is formed by the
small wrist bones, while a strong ligament forms its roof.
Your median nerve runs through this tunnel along with the tendons that bend your fingers and
thumb. When pressure builds within the tunnel, the median nerve can become compressed,
causing numbness, tingling, pain and weakness in the hand.
What does carpal tunnel syndrome feel like?
Common symptoms include:
Numbness or tingling in the thumb, index, middle and part of the ring finger — typically
not the little finger
Waking up at night with a numb or “pins and needles” hand
Weak grip, or dropping things unexpectedly
Swelling and stiffness in the fingers, particularly in the morning
Pain or aching that can sometimes travel into the forearm
Symptoms during prolonged gripping activities such as driving, holding a phone,
gardening or using tools
In more advanced cases, thumb weakness or muscle wasting, which can affect pinching
and grip
Many people instinctively shake or flick their hand to relieve their symptoms. These can be helpful
clues during an assessment, but it's important to note that these symptoms can have other causes
too.
What causes carpal tunnel syndrome?
Carpal tunnel syndrome can develop for a number of reasons.
Common contributing factors include:
Repetitive hand or wrist movements, particularly when combined with sustained or
awkward wrist positions
Prolonged gripping or prolonged flexed positioning of the wrist
Pregnancy, where fluid retention can increase pressure within the carpal tunnel
Diabetes and other metabolic conditions
Rheumatoid arthritis and other inflammatory conditions
Wrist fractures or injuries that alter the shape of the carpal tunnel
Sometimes, there is no clear single cause
It isn't simply a condition caused by “too much typing”. However, prolonged or awkward wrist
positions and repetitive activities may aggravate symptoms.
How is carpal tunnel syndrome diagnosed?
Diagnosis usually starts with a clinical assessment. Your hand therapist or doctor will ask about
your symptoms and may assess sensation, strength, movement and how your symptoms respond
to different positions or activities.
Tests such as Phalen's test or Tinel's test may be used as part of the assessment, although no
single test can confirm carpal tunnel syndrome on its own.
If the diagnosis is unclear, symptoms are more severe, or surgery is being considered, your doctor
may arrange a nerve conduction study (NCS). This can help assess how well the median nerve
is conducting signals and provide information about the severity of the nerve compression.
Your hand therapist can also objectively assess sensation using monofilaments. This provides a
measurable way of assessing sensation and tracking changes throughout your rehabilitation.
How is carpal tunnel syndrome treated?
Treatment depends on the severity of your symptoms and what's causing them. For many people
with mild to moderate symptoms, non-surgical treatment may be appropriate initially.
Treatment may include:
Splinting — keeping the wrist in a neutral position overnight, and sometimes during the
day, can help reduce pressure on the median nerve and is a commonly recommended firstline
treatment
Activity and ergonomic modification — adjusting your workstation, keyboard and mouse
position, grip habits and other activities that aggravate symptoms
Activity pacing — taking regular breaks from repetitive or sustained gripping tasks
Nerve and tendon gliding exercises — specific exercises that may be appropriate for
some people
Corticosteroid injection — your therapist can help guide whether this may be appropriate.
It can provide temporary symptom relief in some cases and may be considered as part of a
broader treatment plan
Surgery — carpal tunnel release may be recommended when symptoms are severe, there
is significant weakness or muscle wasting, nerve testing shows substantial compression, or
symptoms have not improved with appropriate conservative treatment
Carpal tunnel release is a common procedure that involves releasing the ligament forming the roof
of the carpal tunnel to reduce pressure on the median nerve.
Do I need hand therapy for carpal tunnel syndrome?
A hand therapist can play an important role in assessing and managing carpal tunnel syndrome,
both as part of conservative treatment, when guiding whether further medical assessment, a
surgical opinion or a corticosteroid injection may be appropriate, and during recovery after surgery.
Before surgery — or instead of surgery
Your hand therapist can help with:
Assessment of your symptoms, hand function and contributing activities
Custom-made splinting to keep your wrist in a comfortable, neutral position
Activity modification to reduce aggravating movements and positions
Ergonomic advice tailored to your work and daily activities
Nerve and tendon gliding exercises, where appropriate
Advice about when further medical assessment or investigations may be needed
The aim is not simply to give you a wrist splint. Your therapist can assess what's contributing to
your symptoms and help determine the most appropriate treatment pathway. Your therapist will
continue to evaluate the effectiveness of the intervention and help guide your treatment as your
symptoms change.
After carpal tunnel surgery
Hand therapy may also be useful following surgery, particularly if you are experiencing ongoing
stiffness, sensitivity, weakness or difficulty returning to normal activities.
Treatment may include:
Scar management to reduce sensitivity and improve tissue mobility
Desensitisation techniques if the scar or palm is particularly sensitive
Gentle movement and strengthening, progressed appropriately as healing allows
Nerve gliding exercises, where appropriate
Guidance on returning to work, sport and hobbies
Strategies to gradually rebuild grip and hand function
How long does recovery take?
Recovery varies depending on the severity and duration of your symptoms and whether you have
conservative treatment or surgery.
With conservative treatment, some people notice improvement within several weeks, particularly
with consistent splinting and activity modification.
After surgery, symptoms such as night-time numbness and tingling may improve relatively quickly,
but recovery of grip strength, sensitivity and function can take several weeks to many months. If
the nerve has been compressed for a long time, some symptoms may take longer to improve and,
in some cases, may not completely resolve.
When should I get carpal tunnel symptoms checked?
Don't wait until numbness becomes constant or significant weakness develops.
If you're regularly waking at night with numbness or tingling, experiencing symptoms in your
thumb and fingertips, dropping things, or noticing changes in your grip, it's worth having your
symptoms properly assessed.
Early assessment can help identify the likely cause and severity of your symptoms and determine
whether conservative treatment is appropriate or whether further medical assessment or
investigation is needed.
Book a hand therapy appointment
If numbness, tingling or hand weakness is affecting your sleep, work or everyday activities, our
hand therapists can assess your symptoms and help guide your treatment.
We can provide custom-made splints, activity modification advice, exercises and rehabilitation, and work with your doctor or specialist when further investigation, injection or surgery may be appropriate.
Whether you're looking for help managing carpal tunnel symptoms without surgery or recovering
after carpal tunnel release, we're here to help you get your hand functioning as normally as
possible.
Not sure whether hand therapy is right for you? Contact us and we can help you understand the
next step.
Important information
This article provides general health information and is not a substitute for individual medical
assessment or advice. Carpal tunnel syndrome can have different causes and symptoms can
overlap with other conditions. The appropriate treatment will depend on your individual
circumstances. If you have significant or worsening weakness, persistent numbness or other
concerning symptoms, seek appropriate medical assessment.
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