Wrist & hand Orthopaedic Rehabilitation
Carpal Tunnel Syndrome
- Pins and needles in the thumb, index and middle fingers
- Night symptoms that wake you and are relieved by shaking the hand
- Weak grip, dropping objects
- Numbness that spares the little finger
Quick answer
Carpal tunnel syndrome is compression of the median nerve at the wrist, causing pins and needles and numbness in the thumb, index and middle fingers, classically worse at night. Mild to moderate cases respond to night splinting, nerve gliding and activity modification over six to twelve weeks.
Typical recovery
6–12 weeks for mild to moderate cases
A typical range, not a promise — how long it takes depends on how long it has been going on, and on what you do between appointments.
The median nerve passes into the hand through a narrow tunnel at the wrist, alongside nine tendons. When pressure inside that tunnel rises, the nerve is compressed.
What it feels like
Pins and needles and numbness in the thumb, index and middle fingers — and characteristically not the little finger, which is supplied by a different nerve. Symptoms are typically worst at night, waking people who then shake the hand to relieve it. Grip weakens and small objects get dropped. Long-standing cases show wasting of the muscle at the base of the thumb.
Why it happens
Anything that raises pressure in the tunnel: repetitive gripping and wrist work, vibration, fluid retention in pregnancy, hypothyroidism, diabetes, rheumatoid arthritis, and previous wrist fracture. Frequently there is no single identifiable cause.
How physiotherapy helps
- Night splinting in a neutral wrist position — the single most effective conservative measure, because most people sleep with the wrist bent, which raises tunnel pressure
- Nerve gliding exercises to restore the median nerve's ability to move
- Hands-on treatment at the wrist and forearm, and assessment of the neck, since the nerve can be compressed at more than one point
- Modifying grip, tool use and workstation setup
How long it takes
Mild to moderate cases usually improve over six to twelve weeks. Where there is constant numbness or visible thumb muscle wasting, nerve conduction studies and a surgical opinion are appropriate — persistent compression eventually causes permanent nerve damage, and waiting too long costs recovery.
Medically reviewed by Nasir Mughees, BPT, MPT, Orthopaedic Physiotherapy · Last reviewed September 2026