Pain guide · Wrist and hand pain
The carpal tunnel is a narrow passage at the front of the wrist. The median nerve and the tendons that bend the fingers run through it. When the tunnel swells it squeezes the nerve, causing aching, tingling, pins and needles or numbness in the thumb and first fingers, usually worse at night, and later a weak thumb or trouble gripping. Many people find that hanging the hand out of bed or shaking it helps.
It can settle on its own, especially in pregnancy, but often doesn't. A night splint is the usual first step; exercises are an optional add-on with weak evidence; an injection gives faster relief; and surgery helps the most people recover when symptoms persist. This page compares them honestly.
Exercise is for pain that has been checked or is clearly mild and settling.
You're more likely to get it if you're overweight or pregnant, do work or hobbies with repeated wrist bending or hard gripping (especially with vibrating tools), have arthritis, diabetes or thyroid disease, have a parent, brother or sister with it, or have injured the wrist before.
In UK GP records, women were about twice as likely as men to have it, and by 2013 the median age at diagnosis was 54 in women and 59 in men.
In a Swedish survey of 2,466 adults, 14.4% reported tingling or numbness in the area the median nerve supplies, but only 3.8% had clinically certain carpal tunnel syndrome, and 2.7% had it confirmed by nerve tests.
Source 4
The NHS says it sometimes gets better on its own in a few months, especially in pregnancy. But in studies of people treated without surgery, 57% to 66% of the groups that reported it went on to have an operation. Longer symptoms, a positive Phalen's test (symptoms when the wrist is held bent) and thinning of the muscle at the base of the thumb predicted a poorer outcome.
So some people settle and many don't. Waiting a long time with constant numbness or a weak thumb is not a good plan.
Usually from your symptoms and an examination. A nerve conduction test is used when the diagnosis is unclear. The US orthopaedic surgeons' guideline says a validated symptom-and-examination score can be used instead of routine nerve tests, and advises against MRI for diagnosing it.
A trapped nerve in the neck or at the elbow can cause similar tingling.
The NHS advises a splint that keeps the wrist straight at night and says it can take up to 6 weeks to help. In a Cochrane review of 29 trials (1,937 adults), splinting gave little or no short-term symptom benefit over no treatment on average (low certainty). But in one trial of 80 people, night splints made overall improvement much more likely: for every 2 people splinted, about 1 more improved.
Six months of splinting may beat six weeks, and it is unclear whether wearing it all day beats nights only. Side effects were temporary. Because splints are cheap and have no plausible long-term harm, the reviewers concluded small effects could justify them, especially for people who don't want an injection or surgery. The Chartered Society of Physiotherapy also suggests a daytime working splint if particular tasks bring symptoms on.
The NHS says there's a small amount of evidence that hand exercises help ease the symptoms. A Cochrane review (16 trials, 741 people) found limited, very low-quality evidence of benefit from exercise and mobilisation. A 2021 meta-analysis of 22 trials (1,203 people) found nerve glides improved pain and function a little, on very low-certainty evidence, with no effect on symptom severity, nerve tests or grip; a 2023 meta-analysis reported larger effects but with very mixed results between trials. In the trials, glides were usually added to other treatment rather than tested alone.
In the trial most often cited, 28 people wore splints with or without nerve and tendon glides for 4 weeks: both groups improved, and the glide group did slightly better, but not significantly. The US orthopaedic guideline found exercise doesn't improve long-term outcomes. Glides are cheap and safe and may make you feel a little better while you wear a night splint; they are not a reason to delay an injection or a surgical opinion when symptoms are constant or the thumb is weak.
In a UK trial in general practice (234 adults with mild or moderate carpal tunnel syndrome), one steroid injection gave better symptoms and function at 6 weeks than 6 weeks of night splints, with no side effects reported. But the US orthopaedic guideline makes a strong recommendation that injections don't give long-term improvement, and the same UK trial found no difference from splints at 1 to 2 years. A network meta-analysis found the relief within 3 months was modest.
The NHS says injections are not always a cure, and symptoms can come back after a few months. An injection is a good way to get quick relief, not a long-term fix.
In a Dutch trial of 934 people with carpal tunnel syndrome for at least 6 weeks, confirmed by tests, starting with surgery led to recovery at 18 months in 61%, against 45% starting with an injection. In another trial of 176 people, success at 18 months was 90% after surgery and 75% after night splinting, but 41% of the splint group had had surgery by then. In a third trial, surgery did modestly better at 12 months than a non-surgical programme that included hand therapy, and both groups improved.
A Cochrane review (14 trials, 1,231 people) found surgery probably leads to more improvement than splinting in the long term, but probably no important difference in symptom or function scores. Its authors suggest people with tolerable symptoms can start without surgery, and people with severe symptoms who want the best chance of improvement may choose it.
The NHS says the operation usually cures it, takes about 20 minutes under local anaesthetic, and you go home the same day; getting back to normal activities takes about a month.
Built from the trials and guidelines above:
The US orthopaedic guideline found that oral steroids, kinesiology tape, laser, shockwave, massage, manual therapy, heat, magnets, supplements, diuretics, anti-inflammatory tablets and many other treatments don't improve long-term outcomes or don't beat placebo, and that therapeutic ultrasound gives no long-term improvement. The NHS says painkillers may help in the short term, but there's little evidence they treat the cause.
A meta-analysis found no clear link between computer work and carpal tunnel syndrome, and two large cohorts found none with new cases; it was far more common in jobs with forceful hand work. Two small trials of ergonomic keyboards gave too little evidence either way. Breaking up long spells of bent-wrist gripping is still sensible (the NHS advises cutting down activities that make you bend your wrist or grip hard); it just isn't the cause or the cure.
Some discomfort during these exercises is fine and doesn't mean you are doing damage. Keep it to about 5 out of 10 or less. It should settle within half an hour or so, and your hand should be no worse the next morning. If it is, do fewer, smaller or lighter next time, not nothing. An NHS wrist rehabilitation booklet uses the same limit: an unpleasant stretch of about 5 out of 10 that settles within 30 minutes.
Tingling and numbness are different. With nerve glides, a little extra tingling is expected but should fade within an hour, as an NHS hand-therapy leaflet puts it. Stop and get advice if numbness spreads, lasts, or your grip or thumb gets weaker.
Don't rest the hand completely for long, either: for repetitive strain, the NHS says resting for more than a few days makes the area weaker and less flexible. If a joint becomes hot, red and swollen, stop and get it checked.
Start at the first stage. Each move opens a full guide with a 3D demo.
Weeks 0 to 6, alongside a splint that keeps the wrist straight at night (the NHS says give it up to 6 weeks). If symptoms wake you, hang the hand out of bed or shake it. A little extra tingling during the glides is fine if it fades within an hour. Doses are editorial starting points unless a trial or leaflet is named.
3D demoMedian nerve glide (six hand positions, for carpal tunnel)Beginner · No equipment5 rounds, about 7 s in each position · 3 times a day: the protocol in a carpal tunnel trial
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment5 rounds, about 7 s in each position · 3 times a day, from the same trial; or 4 to 6 of each, 4 times a day, as in an NHS leaflet
Harder: Ball squeeze
3D demoWrist & forearm flowBeginner · No equipment10 slow reps, a few times a day · Gently
Harder: Wrist flexor stretch
3D demoMedian nerve slider (neck-to-arm nerve glide)Beginner · A bench or box10 slow reps, 2 to 3 times a day · Only if the neck or upper arm is involved too; start with the arm by your side
Move on when: Night waking is less frequent and the glides don't leave tingling for more than an hour. If numbness becomes constant or the thumb gets weaker, stop and see a GP instead.
About weeks 2 to 8, as night symptoms ease. Keep the glides going if they help.
3D demoBall squeezeBeginner · Other / check instructions3 sets of 10, 5 s holds · A soft ball: the Chartered Society of Physiotherapy's hand squeeze dose
Harder: Band finger extension
3D demoReverse wrist curlBeginner · A dumbbell + A bench or box3 sets of 10, light · The CSP's wrist lift with a tin; add weight gradually
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoWrist curlsBeginner · A dumbbell2 sets of 10, light
Easier: Wrist-extensor eccentrics · Harder: Seated One-Arm Dumbbell Palms-Down Wrist Curl
3D demoWrist flexor stretchBeginner · A wall3 holds of 15 to 30 s · Gentle: ease off at any tingling
Easier: Wrist circles · Harder: Quadruped wrist rocks
3D demoBand finger extensionBeginner · A band2 sets of 10 to 15
Easier: Ball squeeze · Harder: Band overhead triceps extension
Move on when: These pass the pain rule and night symptoms keep easing.
From about week 6, once symptoms have settled. The Chartered Society of Physiotherapy suggests continuing its exercises for at least 6 to 8 weeks after an injection to help stop symptoms coming back; no trial has tested that.
3D demoDumbbell forearm rotationBeginner · A dumbbell + A bench or box2 sets of 10
Easier: Wrist-extensor eccentrics · Harder: Dumbbell reverse curl
3D demoHammer curlBeginner · A dumbbell2 to 3 sets of 10 to 12
Easier: Seated dumbbell curl · Harder: Alternating hammer curl
3D demoFarmer's carryBeginner · A dumbbell + A kettlebell3 walks of 20 to 30 m
Harder: Suitcase carry
3D demoWall push-upBeginner · A wall2 sets of 8 to 12 · Only if bending the wrist back doesn't bring on tingling
Harder: Push-up
3D demoIncline push-upBeginner · A bench or box2 sets of 8 to 12 · Once the wall push-up is comfortable
Harder: Push-up
Move on when: Daily tasks and sleep are back to normal. If symptoms return, go back to the splint and the first stage, and see a GP if they don't settle.
The NHS says getting back to normal activities takes about a month. The US orthopaedic guideline advises against routine supervised therapy and against a splint or sling after the operation, and found mini-open and keyhole release give the same results. Moving your fingers early with tendon glides is sensible (editorial); follow your surgeon's advice on the wound and when to load the hand.
Painkillers may help in the short term, but there's little evidence they treat the cause. Use the splint and the plan, and see a GP if it isn't improving.
Source 1
| Habit or position | Why it matters | Instead |
|---|---|---|
| Sleeping with the wrists curled | Symptoms are usually worse at night, and a splint keeps the wrist straight. | A night splint; hands loose by your side (editorial). |
| Long spells of bent-wrist gripping or vibrating tools | The NHS lists these among the things to cut down. | Breaks every 30 to 60 minutes, larger or padded handles, swapping hands (editorial). |
| Holding a phone or tablet with a bent wrist for long | It keeps the wrist bent (editorial). | Prop the device up, and switch hands. |
| Strong wrist stretches that bring on tingling (a hard wall stretch, or kneeling with palms flat and fingers pointing back) | Tingling means the nerve is being provoked; a gentle pull is enough (editorial). | A gentle wrist flexor stretch, or the median nerve glide instead. |
| Weight through a bent-back wrist that brings on tingling (push-ups, downward dog) | Editorial: it holds the wrist bent back under load. | Fists, push-up handles or dumbbells; a forearm plank; a higher incline. |
Hold 2 to 3 times for 20 to 30 seconds, a mild stretch, never sharp.
| Stretch | Reasonable for | Take care or skip | Why |
|---|---|---|---|
| Median nerve glide (six hand positions, for carpal tunnel) | Carpal tunnel symptoms; before bed | Numbness that spreads or lasts; a weak thumb | Slides the nerve through the carpal tunnel. Very low-certainty evidence of a small effect. |
| Tendon glides (hand tendon gliding exercises) | Carpal tunnel; stiff fingers; after surgery | None within comfort | Moves the finger tendons that share the tunnel with the nerve. |
| Wrist & forearm flow | Nearly everyone; desk breaks | None within comfort | Active movement with no load. |
| Wrist flexor stretch | Desk stiffness, held gently | Ease off at any tingling | A strong pull with the wrist bent back can bring symptoms on (editorial). |
| Median nerve slider (neck-to-arm nerve glide) | Symptoms that also involve the neck or upper arm | The first, most painful days of a pinched nerve | The neck-to-arm glide, different from the hand glide above. |
A little, perhaps, in the short term. Reviews of nerve-gliding exercises found small improvements in pain and function on very low-certainty evidence, and the US orthopaedic guideline found exercise doesn't improve long-term outcomes. Use them alongside a night splint, not instead of getting help.
At night, for up to 6 weeks before you judge it, the NHS says. A Cochrane review found low-certainty evidence that 6 months of splinting may beat 6 weeks, and it is unclear whether wearing it in the day as well helps more than nights only.
For quick relief, yes: in a UK trial of 234 people, one injection gave better results at 6 weeks than 6 weeks of night splints. It doesn't give long-term improvement, and the NHS says symptoms can come back after a few months.
When symptoms persist or get worse, especially constant numbness or a weak thumb. In a trial of 934 people, starting with surgery led to recovery at 18 months in 61%, against 45% starting with an injection. The NHS says surgery usually cures it, and getting back to normal activities takes about a month.
It hasn't been shown to. Two large cohorts found no link between computer work and new cases, and carpal tunnel was more common in jobs with forceful hand work. Breaking up long spells of bent-wrist work is still sensible.
Carpal tunnel affects the thumb, index and middle fingers and is worse at night and with bent wrists. A pinched nerve in the neck usually sends a band of pain down one arm and changes with neck movement. Tingling in the ring and little fingers, worse with the elbow bent, is usually the ulnar nerve at the elbow. Both hands numb and clumsy with unsteady walking needs urgent assessment.
It is common in pregnancy and often settles after the birth. A night splint is the usual first step, and the glides on this page are gentle to try. Ask your midwife or GP before any injection; no source on injections in pregnancy was checked for this page.
The NHS says symptoms are usually worse at night. Wrists often curl during sleep, and a splint stops that (editorial). Hanging the hand out of bed or shaking it eases symptoms for many people.
Follow your surgeon's advice. The US orthopaedic guideline found routine supervised therapy and a splint after surgery aren't needed; moving the fingers early with tendon glides is sensible (editorial). Most people are back to normal activities in about a month.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
