Symptoms

These are the problems that you report to the doctor

• Pins and needles in the thumb, index and middle fingers
• Especially worse at night
• Wake from sleep and shake hand to gain relief

Examination

These are the physical abnormalities your doctor may see

• Wasting on the heal of the hand on the thumb side (thenar eminence)
• Tinel's Sign : tapping the nerve on the front of the wrist causes pins and needles into the thumb, index and middle fingers
• Modified Phalen's Sign : bending the wrist forwards towards the palm especially if the doctor presses on the nerve at the front of the wrist reproduces your symptoms

 Investigations

• Nerve conduction studies : small electrical pads are placed on the fingers and the speed of nerve impulse is recorded across the carpal tunnel. If it is slowed then it is likely the patient has carpal tunnel syndrome.
• None : Sometimes the symptoms and examination are classical of carpal tunnel syndrome and nerve conduction studies are not arranged.

Treatment

• Activity avoidance
• Splints
• Steroid injection : usually only temporary
• Carpal tunnel release : Simple procedure under local anaesthetic, operative time 10 minutes