Signs /Symptoms

  • Pain, numbness, burning or tingling  in median nerve distribution of hand - thumb, index and middle fingers and half of the ring finger. 
  • Symptoms often worse at night/first thing in morning
  • May have difficulty holding / dropping objects
  • Feeling of hand weakness, reduced sensation and reduced grip strength
  • Positive on provocative testing i.e. Tinels, Durkans, Phalens median distribution, little finger usually spared

Advice in Primary Care

  • Vary activities during the day, minimising tasks that require repeated squeezing, gripping, wringing, etc.
  • Alternate activities between heavier and lighter activities to reduce any strain.
  • Avoid prolonged wrist flexion/extension for any period of time.
  • Hanging arm out of bed or shaking the hand, when they are numb or tingling may help
  • If overweight, losing some weight may help
  • Symptoms can settle within a year or so in 1 in 4 cases. So, not treating is an option, particularly if symptoms are mild or if pregnant or under 30 years old

Actions in Primary Care

Referral to Secondary Care

  • Moderate/Severe symptoms including thenar muscle wasting
  • Symptoms involving ulnar nerve; nerve conduction tests may be required
  • If symptoms persist following 6-8 weeks of self management

Refer via SCI Gateway to Occupational Therapy Hand Clinic and include following in referral:

  • Duration of: self management - ? tried splint for 6 weeks or more
  • Precipitating factors i.e. injury/trauma, Occupation
  • Provocative testing (Tinel’s Durkan’s, Phalen’s) results , median distribution or not,
  • Night-time symptoms
  • Hand dominance , activity related symptoms

Editorial Information

Last reviewed: 30/05/2024

Next review date: 23/01/2026

Version: 1.1

Reviewer name(s): Jan Beaumont.