The first signs of carpal tunnel syndrome will appear in your first 4 fingers, hand, and sometimes your wrist. The main signs include pain, numbness, tingling, and weakness. But there are variations of these symptoms; so much that many people confuse carpal tunnel syndrome with wrist tendonitis or even arthritis. Several nonsurgical can be tried first to eliminate symptoms. If these fail, surgery may be required.

• Think you have carpal tunnel? Complimentary self-test
• Already know you have carpal tunnel? This Quiz tells you its severity

Carpal tunnel syndrome (most just call it "carpal tunnel" for short) is a common hand disorder. In fact, after sprains and arthritis, it's the most common hand disorder doctors see. It affects over 5 million Americans.

Carpal tunnel is actually a type of neurological disorder of the median nerve. This nerve is a main motor and sensory nerve in the hand and fingers. Carpal tunnel occurs because the median nerve becomes crushed and "trapped" inside a narrow space in the interior of the wrist joint. 

Nerves don't like being crushed. As a result, they transmit signals to the brain that are interpreted as uncomfortable symptoms in the fingers, hand, and wrist. These are they very first signs of carpal tunnel syndrome and include:

• pain
• numbness
• tingling (pins & needles)
• burning
• soreness
• puffy feeling
• itching
• shooting electric shocks
• hand weakness
• finger or hand clumsiness
• loss of finger dexterity

Hand weakness occurs because the median nerve can no longer efficiently transmit signals to the muscles of the hand. Likewise, finger dexterity suffers, and the person feels like their hand or fingers are awkward or clumsy.

Usually the signs of carpal tunnel first begin on the thumb and index finger. Note that the little (pinky) finger is never involved in carpal tunnel syndrome because the median nerve doesn't travel to it. 

If you have any of theses signs or symptoms in your little finger, then you may have tendonitis instead. You can determine if you have carpal tunnel syndrome or tendonitis by performing these self tests.

Even though the signs of carpal tunnel syndrome are very clear, nobody is really certain how it happens in the first place. Most doctors classify carpal tunnel syndrome as a type of repetitive stress injury or RSI. That means when your hand and fingers undergo repetitive and forceful motions for long periods of time, injury can result to your tendons. 

Tendons are the ropy structures that make muscles move. In the arm, they run from the middle of the forearm (where the muscle is) to your fingertips. 

Injury to tendons causes them to inflame and swell. Almost everybody knows that swelling causes pain. So when tendons become injured and swell, any muscle movement (like moving a finger) can be very painful. 

But the scenario is a little more complicated with carpal tunnel syndrome. Sure, rapid and forceful finger movements cause tendon injury and swelling. But if the tendon swelling happens inside the narrow wrist joint, another problem occurs. The swollen tendons push against the median nerve. 

Think of the swelling like a fist full of drinking straws. The most center straw is the median nerve. And the surrounding straws are the tendons. As the straws expand and swell (as injured tendons do), they press into the central straw (the median nerve). Eventually, the center position is crushed down. 

Therefore, carpal tunnel syndrome is caused when the tendons passing through the wrist joint swell and push against the median nerve until it's crushed. When it's crushed, the nerve reacts by transmitting the sensations of pain or numbness. These constitute the first signs of carpal tunnel syndrome. 

First and foremost, anybody can get carpal tunnel syndrome. However, the signs of carpal tunnel are most likely to appear in people who are at high risk for getting the disorder. These high risks are:

• people with a family history of carpal tunnel
• pregnancy
• being female
• working in jobs that repetitively stress hands
• if you have rheumatoid arthritis
• have broken or sprained your wrist
• diabetes
• high blood pressure
• smoking
• a sedentary lifestyle
• a thin body frame
• overweight or obese
• emotionally stressed

Also, employees of certain occupations more often report having signs of carpal tunnel syndrome. They have a higher incidence of developing the disorder because they all have one thing in common: they perform harmful hand activities like rapid, forceful or extensive grip-and-release movements. The occupations at highest risk are:

• hairdressers
• accountants
• dental hygienists
• programmers 
• graphic designers
• cashiers
• artists
• construction & carpentry
• musicians
• secretarial
• gamers
• golfers
• knitters
• assembly line workers

Anyone who suspects they have carpal tunnel syndrome should "listen to their hands". That's because the first signs of carpal tunnel syndrome can be very subtle. 

In fact, when carpal tunnel first begins to appear, most people think they just have tired or overworked hands. They don't know they have a progressive disorder creeping up on them. Recognizing the subtle onset of carpal tunnel syndrome is crucial because the longer you wait to treat it, the harder it will be to get rid of symptoms.

Here are tips for identifying the first signs of carpal tunnel syndrome

• First, recognize if you're at risk for developing carpal tunnel (see section above).
  
• Next, recognize if you're in a high risk occupation (see section above).
  
• Take note on how many hours you stress your hand and fingers during the day.
  
• Determine whether your hand merely feels "tired" as opposed to having real symptoms.
  
• Do you feel pain, numbness, tingling, burning, soreness, itchiness, weakness or swollen feelings in your hand or fingers?
  
• Do you feel shooting electric shocks going up your hand, especially when gripping something like a phone or mug?
  
• Is your hand clumsy and do you drop things often?
  
• Are you having difficulty picking up small objects like coins or keys?
  
• Is is hard to tie a shoelace or button a shirt?
  
• Are any of these symptoms especially noticeable when you're trying to sleep or when you wake up in the morning?
  

Usually, this neurological disorder progresses if there's not attempt at treatment. That means any signs of carpal tunnel you have now will probably become more intense as weeks and months pass if you don't take action immediately. 

Generally speaking, patients advance from "barely noticeable" to "severe" symptoms within about 6 months. However, this time frame is highly variable. For instance, some patients may feel minor pain or tingling for a year or two until symptoms start to worsen. Others may see symptoms escalate within a month of first noticing them.

Also, the rate of progression is variable from person to person. Usually symptoms worsen more and more with each passing week or month. Other times pain or numbness may be at a low level for a year or two, and then escalate quickly and drastically. 

On rare occasion, severe pain and numbness are felt at the very beginning. In other words, in a few patients intense pain and numbness are the very first signs of carpal tunnel syndrome.

Every doctor advises that when you feel the first signs of carpal tunnel syndrome (literally, the VERY FIRST signs), you should treat it right away. That's because this progressive disorder will mostly likely advance if you just leave it alone.

Fortunately, there are highly effective treatments for carpal tunnel syndrome. The most radical treatment is carpal tunnel release surgery. This is when doctors surgically open your palm to relieve pressure on the median nerve. But surgery isn't for everybody. In fact, this type of hand surgery is only about 50% successful when assessed 2 years after the operation.

In contrast, there are reliable and effective non-surgical alternatives, even for severe symptoms. These include avoidance & rest, night bracing, stretching exercises, myofascial release massage, steroid shots, and hydrodissection.

At the very first signs of carpal tunnel syndrome, stretching exercises should be you primary preventive tool. It might sound incredible, but finger and hand stretching exercises are powerful carpal tunnel fighters. A faithful regimen of the right kind of finger and hand stretching exercises will have profound positive effects.

Even more amazingly, the best stretching exercises only take a few seconds to do! So they're easy to incorporate into your work schedule while you take your "mini rest breaks". These are the quickest and most effective "core carpal tunnel stretching exercises".

Night bracing is crucial but many people overlook it's importance. Whether you have advanced symptoms or merely the faintest first signs of carpal tunnel syndrome, night bracing is very important. 

However, you should NEVER wear a wrist brace during the daytime as you work with your hand. Doing so will make your hand fight the brace, further stressing the tendons in your wrist. This makes the carpal tunnel much worse.

Furthermore, NEVER wear a generic wrist brace at night (the kind sold at your local pharmacy). These braces are generally made for sprains, and usually contain a metal spine on the palm's surface. Such a feature will make your carpal tunnel symptoms worse. Click here to find out why, and to see how to choose a certified carpal tunnel night brace.

Perhaps the most reliable carpal tunnel fighter is myofascial release massage. This is the primary treatment used by physical therapists for their carpal tunnel patients. The therapy breaks up restrictions on the tendons inside the wrist joint. Those restrictions are the cause of the inflammation and swelling, which are at the core of carpal tunnel syndrome. Myofascial release massage also promotes blood flow and drains excess fluid build-up inside the wrist joint. 

Combined, these benefits permanently eliminate the signs of carpal tunnel syndrome. The downside is that myofascial release massage is required daily and for at least 30 days to see good results. In addition, you cannot easily perform myofascial release massage on yourself. That means you must visit a physical or massage therapist regularly, or recruit a willing partner to help. You can also use the FDA cleared CarpalRx device which performs the identical massage automatically.

Most people believe steroid shots are the answer to eliminating any and all signs of carpal tunnel syndrome. But this is incorrect. The steroid injection merely relieves pain temporarily because it reduces inflammation and swelling. Pain relief can last for 4-8 weeks, but usually returns.

Also, carpal tunnel steroid shots are only 45% effective . That means either the shot works in only 45% of patients or the pain is only 45% reduced. 

Moreover, steroid injections can only be used for a limited number of times (usually 3-5 times) in your life. The reason is because there are significant risks and side effects of having steroid shots. Besides, the shots only relieve pain temporarily. They do eliminate the reason you have carpal tunnel syndrome to begin with (that is, swollen tissues like tendons crushing your median nerve).

In the past few years, hydrodissection of the median nerve has been developed. This is a temporary pain relief procedure. Like steroid shots, hydrodissection does not eliminate the reason you have carpal tunnel syndrome. However, the procedure is simple, safe, and successful about 61% of the time.

The procedure requires a 30-40 minute doctor's office visit. The doctor uses ultrasound to guide a needle close to your median nerve. Then the doctor injects fluid close to the nerve. This breaks apart adhesions and frees the nerve from any entrapment and restriction. As a result, the nerve is no longer irritated.

Most patients see relief within days. Satisfaction is good at the two month follow-up visit. Once the effect wears off (after 3-6 months) the procedure can be repeated, and for an unlimited number of times.

Carpal tunnel surgery, also called carpal tunnel release surgery, is used in patients where conservative (nonsurgical) remedies were not effective. The goal of the surgery is to relieve pressure on the median nerve inside the carpal tunnel passageway.

The surgeon must cut the transverse carpal ligament, which forms the roof of the carpal tunnel. Doing so allows the wrist bones to snap apart, creating more room for the nerve. As a result, the nerve is no longer compressed, and symptoms eventually subside.

There are two main types or techniques: open and endoscopic carpal tunnel release. Both have the same goal, which is to cut the transverse carpal ligament. But in the open technique, a large incision is made on the palm. In contrast, the endoscopic technique requires one or two small holes in the palm. The open technique is associated with more postsurgical pain, and more extensive aftercare and recovery time. Both types have similar success rates.

• Is only one sign, like pain, a symptom of carpal tunnel?

It can be. You can have one symptom or multiple ones at the same time.

• Is it better to do several treatments simultaneously?

Yes, doing more than one of the nonsurgical treatments will increase the probability of getting relief.

• Can I do the other nonsurgical treatments even after I get a steroid shot or hydrodissection?

Yes, you can, but you should wait until the irritation of the hypodermic injection wears off - generally after a few days.