Intended for healthcare professionals

Clinical Review

Carpal tunnel syndrome

BMJ 2014; 349 doi: (Published 06 November 2014) Cite this as: BMJ 2014;349:g6437
  1. Scott D Middleton, specialty registrar, trauma and orthopaedics1,
  2. Raymond E Anakwe, consultant hand, wrist, and elbow surgeon2
  1. 1Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Department of Trauma and Orthopaedic Surgery, St Mary’s Hospital, Imperial College NHS Trust, London W1 2NY, UK
  1. Correspondence to: R E Anakwe raymundus{at}

The bottom line

  • Carpal tunnel syndrome is extremely common and is seen in both community and hospital practice

  • A diagnosis of carpal tunnel syndrome should be suspected in patients with intermittent tingling, pain, or altered sensation affecting the fingers in the distribution of the median nerve: the thumb, index finger, middle finger, and radial half of the ring finger

  • Non-operative strategies may be successful for early or mild disease or where advanced disease is associated with minimal symptoms

  • Where non-operative strategies fail, open carpal tunnel decompression provides good results and high levels of reported satisfaction for most patients

Carpal tunnel syndrome is the most commonly diagnosed compression neuropathy of the upper limb. Patients may present to general practitioners, physiotherapists, hand therapists, or surgeons with a variety of symptoms. Several studies have examined the epidemiology, diagnosis, and treatment of carpal tunnel syndrome. We review these resources to provide an evidence based guide to the diagnosis and treatment of carpal tunnel syndrome.

Sources and selection criteria

We searched PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature to identify source material for this review. We examined available evidence published in the English language for the diagnosis and treatment of carpal tunnel syndrome. The search terms used were “carpal tunnel”, “carpal tunnel syndrome”, “tingling fingers”, “median nerve compression”, and “compression neuropathy”. There were no well conducted large randomised trials. We selected and examined smaller randomised trials as well as case series, cohort studies, and observational reports where these provided the only evidence.

What is carpal tunnel syndrome and who gets it?

Carpal tunnel syndrome encompasses a collection of symptoms: patients often mention altered sensation or pain in the hand, wrist, or forearm. The reported prevalence of carpal tunnel syndrome is between 1% and 7% in European population studies, and most studies cite a figure of around 5%.1 2 It has been found to …

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