Carpal tunnel syndrome | Mate kāwititanga o te ringa

Key points about carpal tunnel syndrome

  • Carpal tunnel syndrome (mate kāwititanga o te ringa) is a painful hand condition caused by a pinched nerve in your wrist.
  • It usually starts with a tingling or numbness in your hands and fingers, and becomes increasingly painful.
  • It is 5 times more common in women than in men and occurs most often in people aged between 30 and 60. 
  • It also occurs more often during pregnancy and in people with certain long-term conditions. 
  • It may be brought on by repetitive activities at work, sport or other recreational activities.
  • Treatment aims to reduce pain, tingling and numbness, and restore wrist and hand function.
Wrist support and strapping on right arm
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The main symptoms of carpal tunnel syndrome are thought to be caused by irritation to the median nerve in the carpal tunnel.

The carpal tunnel is a narrow space inside your wrist that is surrounded by bone and ligament. This tunnel protects the finger tendons, nerves and blood vessels where they pass from your forearm into your hand.


Image credit: 123RF

  • With carpal tunnel syndrome, the carpal tunnel swells and compresses the median nerve.
  • This could be caused by thickening of the tendon sheaths, which reduces the amount of space inside the carpal tunnel.
  • As a result, the median nerve may be compressed, and you then feel pain and tingling, particularly on the thumb side of your palm, your thumb and your fingers.
Possible causes of carpal tunnel syndrome

  • Pregnancy: Up to about 50% of pregnant women develop hand and finger pain, possibly due to fluid retention in the carpal tunnel.
  • Injury to your wrist.
  • Other health conditions, such as diabetes, which can make nerves more sensitive, and rheumatoid arthritis, which can cause inflammation of the tendons in your wrist.
  • Repetitive work with your hand.
  • Obesity.
  • Various types of hormonal conditions.
  • A family history of carpal tunnel syndrome. This is because your genes influence things like the anatomical shape of your carpal tunnel.

Carpal tunnel syndrome usually starts with a tingling (pins and needles) or numbness, particularly in your thumb, index finger (forefinger or pointing finger) and middle finger. There may also be general discomfort or numbness in your wrist or arm, and slight weakness of your hand grip. Some people get swelling in their fingers. Symptoms may wake you up at night, but they may also occur during the day. For instance, you may notice symptoms while you are driving or holding a newspaper.

Carpal tunnel syndrome is usually diagnosed by your doctor or physiotherapist. They will perform a physical examination and ask questions to learn more about your symptoms. For example, they will ask about the numbness or tingling you feel, where and when you feel it, and for how long.

Further testing is only required if they want to rule out other conditions that have similar symptoms. Other tests that your doctor may recommend can include:

  • Blood tests – if your doctor suspects an underlying condition, such as diabetes, rheumatoid arthritis or underactive thyroid.
  • Nerve conduction study – to find out if there are changes in the function of the nerves in the wrist and hand.
  • X-ray – to exclude other causes of wrist pain, such as arthritis or a fracture.
  • Ultrasound scan – to examine the structure of your wrist.

Once your problem is diagnosed as carpal tunnel syndrome, you and your health professional will make a treatment plan.

Treatment for carpal tunnel syndrome depends on how bad your symptoms are and how long you have had them. Treatment will also depend on whether you have other conditions that need further treatment such as arthritis, diabetes or another injury. The aim of treatment is to reduce the pressure in the carpal tunnel space. Some people find that symptoms improve within a few weeks. 


Self-care is the first option, particularly if your symptoms are mild or have started during pregnancy. You may be able to ease your discomfort by:

  • taking frequent breaks from repeated activities to rest your hands
  • changing your wrist position
  • avoiding activities or movements that make symptoms worse
  • avoiding prolonged, repetitive or strong gripping of objects
  • avoiding extreme bending of your wrist
  • avoiding gripping equipment or tools that are narrow and slippery as they require more force to hold onto - it may help to get wider and less slippery equipment or tools
  • applying cold packs to reduce any swelling
  • using a removable support (splint) to keep your wrist straight. You can use it during the night or the day, depending on when your symptoms are worst. Splints can often be bought over the counter from a pharmacy.

Note: Squeezing a ball is not helpful for this condition.

Other treatment

If self-care does not relieve your symptoms within a few weeks, or you notice a reduction in the size of the muscles at the base of your thumb, talk to your doctor or physiotherapist. If you leave the condition untreated while your symptoms get worse, permanent nerve and muscle damage can occur. There are a range of treatments available.

  • Physiotherapy or hand therapy may be helpful. It can improve the mobility of your wrist bones and the flexibility of soft tissues in your arm. You may also be given strengthening exercises.
  • Physiotherapists can also provide strategies and solutions for activities at work, such as when using a keyboard.
  • Pain medication such as paracetamol may provide relief.
  • Your doctor may offer cortisone injections, which can also provide short-term relief. 

It is also important to manage any underlying causes, such as diabetes. Losing weight, if you are overweight or obese, is likely to reduce the symptoms.

Treatment for severe symptoms

If symptoms persist for more than 6 months and are interfering with your daily life and work activities, despite self-care and treatment, you may need surgery. Surgery relieves pressure on the trapped nerve and aims to prevent any permanent nerve damage. Your doctor will be able to discuss the most suitable method of surgery with you.

Learn more about carpal tunnel syndrome with this online module.

Carpal tunnel release surgery – online module

Learn more about carpal tunnel syndrome(external link)(external link) with this online module developed by doctors from the American Academy of Orthopaedic Surgeons. Topics range from causes, symptoms, diagnosis, to non-surgical and surgical treatment, risks and complications (audio available). 

Carpal tunnel module(external link)(external link)

Who is this for? Anyone interested in learning more about carpal tunnel syndrome.
Format: Slides with audio (turn on or off).
Source: American Academy of Orthopaedic Surgeons, US

Note: This is a general guide only. See your doctor for personalised advice and note that treatment may vary between New Zealand and other countries. 

The following links have more information about carpal tunnel syndrome. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Carpal tunnel syndrome(external link)(external link) Mayo Clinic, US 
Carpal tunnel syndrome(external link)(external link) NHS Choices, UK
Carpal tunnel syndrome(external link)(external link) OrthoInfo, US
Carpal tunnel syndrome – patient information(external link)(external link) Capital & Coast DHB, NZ, 2020


Carpal tunnel syndrome(external link)(external link) Royal Brisbane and Women’s Hospital, Occupational Therapy, Australia, 2017

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Clinical resources

Surgical versus non-surgical treatment for carpal tunnel syndrome(external link)(external link) Cochrane Database of Systematic Reviews, UK, 2008
Surgical treatment options for carpal tunnel syndrome(external link)(external link) Cochrane Database of Systematic Reviews, UK, 2007
CTS-6 evaluation tool(external link)(external link) East Bay Hand Medical Center, US
Conservative treatments for carpal tunnel syndrome(external link)(external link) Capital & Coast DHB, NZ, 2014

Continuing professional development

Video: Cortisone injection for carpal tunnel syndrome

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(external link)
(external link)

(Counties Manukau Health Orthopaedics)

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Associate Professor Gisela Sole, School of Physiotherapy, University of Otago; Miranda Buhler, physiotherapist and hand therapist

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