Carpal tunnel syndrome: symptoms, assessment and treatment

The median nerve passes through the carpal tunnel in the wrist together with tendons. When the canal becomes narrow, the nerve can be compressed [1].

NHI mentions several possible causes: swelling from tendon inflammation or other irritation, changes in fluid balance and hormones, for example in pregnancy, menopause, low thyroid function, kidney failure or diabetes, rheumatoid arthritis, and changes after a wrist fracture. Repetitive one-sided hand movements over time at work can also play a part. Often there is no clear cause [1].

The condition is fairly common. Up to one in seven adults may be affected. Women are more exposed than men, the occurrence increases with age, and overweight increases the risk [1].

Early symptoms are tingling, numbness or reduced sensation, at times with pain, in the area supplied by the nerve. This applies particularly to the middle and index fingers, and the area also includes the thumb and half of the ring finger. The little finger is not affected [2].

The symptoms are often worse at night or when the arm is held still. Shaking or massaging the hand can ease the symptoms [2].

Later, strength can be reduced, and the muscle at the base of the thumb can lose bulk. Loss of sensation in the fingertips can make it difficult to handle small objects [2].

According to NHI, the diagnosis is usually made from the history and an examination of the hand and arm. If necessary, the diagnosis can be confirmed by measuring nerve conduction velocity (nerve conduction study). This is done, among other things, when surgery is being considered [3].

A summary of American guidelines from 2025 recommends a clinical prediction tool called CTS-6, which gives points based on symptoms and findings. According to the summary, it is as good at establishing the diagnosis as ultrasound and nerve conduction testing. Most people do not need further assessment when the tool is positive. If it is negative but suspicion is high, ultrasound or nerve conduction testing can be considered. MRI is not recommended [5].

The Norwegian guideline on imaging, from 2014, recommends nerve conduction testing instead of imaging when carpal tunnel syndrome is suspected, and describes ultrasound as a good support [6]. You can read more about the choice between imaging examinations in the article on ultrasound or MRI.

For mild to moderate symptoms, the first step is offloading with a wrist splint, preferably at night and possibly for parts of the day. Continuous use should be avoided so that the wrist keeps its normal mobility [4]. In people who are overweight, weight loss can improve the symptoms [4].

A corticosteroid injection can be relevant if the symptoms have lasted more than six weeks. Surgery is considered when a splint and injection have insufficient effect. When symptoms are pronounced, for example weakened grip, NHI recommends surgery earlier in the course [4].

The American summary describes that a corticosteroid injection gives short-term relief, but no improvement after six months to five years compared with conservative treatment such as a night splint. Injection of platelet-rich plasma did not give reliable improvement in symptoms or function [5].

The condition can go away on its own. In about one in three, the symptoms improve after half a year. Symptoms from the median nerve during pregnancy usually improve after the birth [4].

After surgery, pain and discomfort usually disappear almost immediately. Reduced sensation in the hand and fingers can last for weeks, and rarely for months [4].

Weakness in the hand, or the muscles at the thumb becoming smaller, are described as later signs that the nerve is affected [2]. There is then reason to have the symptoms assessed by a doctor.

The same applies if the symptoms have lasted more than six weeks. At that point, more treatment options become relevant [4].

A chiropractor can take a history, examine the hand, arm and neck, and assess whether further investigation is relevant. When needed, diagnostic ultrasound can be used, and the chiropractor can refer on to a specialist. You can read more about chiropractic care at Dr.Dropin.

What is carpal tunnel syndrome?

It is a condition where the median nerve is compressed in the carpal tunnel in the wrist. It can cause numbness, tingling and pain in the palm, thumb, index finger, middle finger and part of the ring finger [1].

Can carpal tunnel syndrome go away on its own?

Yes, it can. In about one in three, the symptoms improve after half a year. Symptoms during pregnancy usually improve after the birth [4].

Why are the symptoms worse at night?

NHI describes that the symptoms often get worse at night or when the arm is held still, and that shaking or massaging the hand can ease them [2]. The sources give no further explanation of why.

Which fingers are affected by carpal tunnel syndrome?

Mainly the middle and index fingers, and also the thumb and half of the ring finger. The little finger is not affected [2].

The article on ultrasound or MRI explains what the two examinations are suited for. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Karpaltunnelsyndrom (Carpal tunnel syndrome). NHI.no. Last updated 29 September 2025. Link

2. Karpaltunnelsyndrom: symptomer (Carpal tunnel syndrome: symptoms). NHI.no. Last updated 29 September 2025. Link

3. Karpaltunnelsyndrom: diagnostikk (Carpal tunnel syndrome: diagnosis). NHI.no. Last updated 29 September 2025. Link

4. Karpaltunnelsyndrom: behandling (Carpal tunnel syndrome: treatment). NHI.no. Last updated 29 September 2025. Link

5. Sadler KP, Torbert DR, Writer JK. Management of carpal tunnel syndrome: guidelines from the AAOS. Am Fam Physician. 2025;112(3):337-339. Link

6. Norwegian Directorate of Health. National guideline: Imaging in non-traumatic musculoskeletal disorders (IS-1899). Published 21 January 2014. Link