Waking Up with Numb Hands? The 5-Minute Carpal Tunnel Guide You Need
⌚️ read time: 5.4 minutes
Let's talk about something that drives people absolutely nuts — waking up in the middle of the night because your hand feels like it's on fire. Or maybe you can't feel it at all. Or both, somehow.
If this sounds familiar, you might be dealing with carpal tunnel syndrome. And you're not alone. This is one of the most common conditions I see in my practice, but there's a lot of confusion about what it actually is and how to treat it.
What's Actually Happening in There?
Think of your wrist like a tunnel (creative, I know). The floor and walls are made of the small bones in your wrist, and the roof is a thick ligament called the transverse carpal ligament. Through this tunnel run the nine tendons that bend your fingers (flexor tendons) and one very important nerve — the median nerve. You can see these outlined in the image below.
Here's where things get interesting.
That tunnel is pretty crowded already. The nerve isn't just sitting there — it needs blood flow from tiny vessels to stay healthy. And those vessels are really sensitive to pressure. When anything changes the available space in the tunnel (swelling, inflammation, even just bending your wrist) that nerve gets squeezed. And squeezed nerves are angry nerves.
The Pressure Problem
Let’s do a few quick numbers. In a normal carpal tunnel, the pressure hovers around 2.5 mmHg (mmHg are arbitrary units of pressure). But once that pressure hits 20-30 mmHg, those tiny blood vessels feeding your nerve start to collapse. Think of it like stepping on a garden hose — the water (in this case, blood to feed your nerves) just can't get through.
And here's the worst part. When that nerve doesn't get enough blood flow, it starts to swell. Swollen nerve in an already tight tunnel? You can see where this is going. It's a vicious cycle that can keep getting worse if we don't intervene.
Why Night is the Enemy
If you have carpal tunnel syndrome, perhaps you've noticed your symptoms are worse at night. This isn't in your head — there's a real mechanical reason for this. When we sleep, most of us naturally curl our wrists. Every time you bend your wrist, that tunnel gets even more cramped.
Not to mention the fluid shifts and lack of movement that occur at night to increase carpal tunnel pressure even further.
Think about it. You can easily spend 6-8 hours with your nerve in the equivalent of a pressure cooker. No wonder you wake up with your hand feeling like TV static.
The Pinky (Almost) Never Lies
Want to know a cool diagnostic trick? Your pinky is your built-in carpal tunnel detector.
In the vast majority of people (a small few have an anatomic nerve cross-wiring), the median nerve doesn't supply any sensation to your pinky finger. So if your pinky is involved in your symptoms, we're probably dealing with something else.
Think pinched nerves in the neck, elbow, or an overlap of sorts.
Classic carpal tunnel symptoms hit the thumb, index, middle, and sometimes half of the ring finger. And they love to show up at night, which is why you might find yourself shaking your hand at 3 AM trying to get feeling back.
When to Worry
Here's something that keeps me up at night as a surgeon: muscle wasting. If you notice the muscles at the base of your thumb (see image below) starting to look smaller than your other hand, that's not just a cosmetic issue. That's permanent nerve damage territory, and you need to see a hand surgeon ASAP.
The other time you should worry? Any time you’re dealing with nerve symptoms for more than a few weeks. It’s ok to try some home remedies or alternative therapies for a while. But if those nerve symptoms persist? You must not ignore them or you are risking nerve damage that even surgery can’t fix.
A Quick Word About Typing
Let's quickly bust a myth while we're here. Despite what you have almost certainly heard, typing probably isn't causing your carpal tunnel syndrome. When computers first became mainstream, some early studies suggested a link. But decades later, with just about everybody typing all day, that connection just hasn't held up in the research.
What actually does increase your risk? Things like repetitive use of vibrating tools (think jackhammers), certain inflammatory conditions like rheumatoid arthritis, and pregnancy (thanks, hormones).
Treatment Options That Actually Work
To put it simply, lots of things get blamed for carpal tunnel, and lots of treatments get suggested (ahem, marketed).
But here's what actually works (ahem, science):
Night Splints: Remember how I mentioned we all bend our wrists at night? A simple splint can prevent this, and it's often the first treatment to try. 6 weeks of consistent nighttime-only bracing is a no-brainer if you’re dealing with carpal tunnel syndrome.
Steroid Injections: These can provide significant relief, though it’s almost always temporary. Most patients get about 3-6 months of improvement. Very few make it to a year (in fact, most have surgery within a year of their injection).
Surgery: A relatively minor procedure that can provide permanent relief when other treatments fail. Downside? It’s surgery.
Notice I didn't mention vitamins, lasers, or special bracelets.
The Surgery Decision
If conservative treatment isn't helping, we might need to talk about surgery. It's actually a remarkably straightforward procedure — we're literally just making more room in that tunnel by dividing the ligament that forms the roof.
Think about it. If you remember back to the anatomy above, we have three options to make the tunnel bigger:
Make the floor deeper (not possible without destabilizing your wrist)
Push the walls further apart (again, structurally impossible)
Raise the roof (bingo!)
Once that roof ligament is divided, the edges retract a bit, and the interior volume of the tunnel immediately expands. No more pinched nerve. The blood rushes back into those microscopic nerve vessels and gets to work at repairing the damage.
Takeaways:
Carpal tunnel syndrome happens when the median nerve gets squeezed in your wrist, often causing numbness and tingling in all fingers except your pinky.
While there are several treatment options, ignoring symptoms for too long can lead to permanent nerve damage.
Many home treatments are worth trying, but if you're losing sleep or noticing muscle loss, it's time to see a specialist.
Look, dealing with carpal tunnel can be frustrating. But the good news is we have reliable ways to treat it. The only thing you have to do is promise me you won’t ignore ongoing nerve symptoms.
If you found this helpful, share it with that friend who's always a bit groggy in the morning. Who knows, maybe their numb hands have them up staring at the clock night after night. I’m sure they’ll thank you later.
Whenever you're ready (or need all of the information), I can help:
Your Little Guide: Carpal Tunnel Syndrome is my masterclass on carpal tunnel syndrome. In this short book, I share everything you ever wanted to know about numb hands and how to fix them. More education than the average visit to a specialist — for less than the average co-pay.
