In most cases, carpal tunnel syndrome (CTS) begins slowly, with a slight aching of the wrist that extends to the hand or forearm. This pain initially may be felt only at night. One or both wrists may be involved. Other common signs and symptoms include:

• Tingling and/or numbness of the fingers and/or hand. The thumb, index, middle and ring fingers are affected, but the median nerve does not serve the pinky. Sensations of tingling and numbness are more apparent while engaging in certain activities, such as driving a vehicle or holding a phone or other object. To relieve this symptom, many people shake out their hands.
  
  
• Radiating wrist pain. Pain that radiates or extends from the wrist up the arm to the shoulder or down into the palm or fingers is a symptom of CTS. This is especially common after forceful or repetitive use. In most instances, this occurs on the palm side of the forearm.
  
  
• Weakness of the hands or a tendency to drop objects, even if they are not heavy, in cases of advanced CTS.
  
  
• Permanent loss of feeling in some fingers. This can occur if CTS is advanced.

People with CTS usually experience an increase in symptoms at night and when they awaken each morning. This may be due to their daily activities, which can exacerbate symptoms (e.g., repetitive hand motions, use of power tools) and their sleeping habits (if they sleep with their wrist bent), which can result in numbness and/or pain upon awakening.

In addition, research indicates that CTS patients who smoke cigarettes usually experience more severe symptoms and tend to recover more slowly than nonsmokers.

Left untreated, symptoms can become progressively worse and may result in permanent nerve damage and the loss of hand and wrist strength due to muscle wasting (atrophy). Eventually, CTS patients may have trouble differentiating between hot and cold by touch.

Individuals who experience any persistent symptoms, especially if they interfere with sleep or other daily activities, are advised to contact their physician for an evaluation. With proper treatment, most CTS patients experience relief from the pain and numbness and regain normal use of their wrists and hands.