Why do my hands hurt at night?

Written by: Mr James Nicholl
Edited by: Laura Burgess

The most common cause for people complaining of pain in their hands, which wakes them up at night is carpal tunnel syndrome. This pain is often associated with numbness and pins and needles in the fingers.

What is carpal tunnel syndrome?

Carpal tunnel syndrome is a condition where the median nerve, which is one of the main nerves running into the hand gets compressed as it runs through a space in the front of the wrist. Initially, the symptoms experienced can be intermittent pins and needles in the fingers with often the little finger least affected. This can progress to intermittent numbness and sometimes constant numbness. Situations, where the symptoms are likely to occur, are when somebody is sitting reading or when they are driving.

What has it been described as feeling like and why is it more noticeable at night?

At night, because we do not tend to move our hands and fingers and often sleep with our wrists in a bent position this increases the pressure within the carpal tunnel and will precipitate the symptoms. People with carpal tunnel syndrome often complain that when they wake up their fingers are most numb. When severe the symptoms will wake them, sometimes several times a night with not only the numbness and pins and needles in the fingers but also pain which can spread right up through the arm to the shoulder and a feeling of the fingers feeling swollen and stiff.

Carpal tunnel syndrome is more likely in patients with diabetes and can occur during pregnancy. If it does then once the baby is born the symptoms will often resolve, although this is not always the case.

Can it go away by itself?

Some patients with carpal tunnel syndrome will find that their symptoms disappear without any intervention. If the symptoms persist, particularly if they are disturbing somebodies sleep then sleeping with a wrist support or splint can be beneficial in controlling the symptoms. If the symptoms persist then it is sensible to consult a doctor. The diagnosis of carpal tunnel syndrome is usually made on the history given by the patient and the diagnosis is supported by finding certain physical signs when the wrist is examined. In most cases, carpal tunnel syndrome can be diagnosed in this way but if there is uncertainty then an electrical test called a nerve conduction test can be performed. This test, however, is not always positive in patients with carpal tunnel syndrome.

How does a doctor treat CTS?

Once the diagnosis of carpal tunnel syndrome has been established, if it requires treatment then as stated above wearing a splint at night can be tried. A cortisone injection into the carpal tunnel will often relieve the symptoms although the beneficial effect is often only temporary.

If carpal tunnel syndrome is allowed to progress then patients can develop a permanent numbness with decreased sensitivity in the fingertips such that they struggle to perform fiddly tasks and can drop things. The muscle in the pad of the hand can waste away. Ideally, carpal tunnel syndrome should be treated before it progresses to this degree of severity. If the symptoms are severe and certainly if a patient is developing a permanent numbness or muscle weakness then the treatment is a surgical release of the nerve by an operation called a carpal tunnel decompression. This is almost always performed under a local anaesthetic and the surgery takes about ten minutes.

From the point of view of recovery afterwards I apply a padded bandage to the wrist which is removed after 48-hours and then ask my patients to keep a dressing over the wound and to keep it dry for twelve to fourteen days. A carpal tunnel decompression will normally relieve any intermittent symptoms immediately but if there is permanent numbness in the fingers recovery of sensation becomes less predictable but often will occur over a few months.


If you have severe symptoms of carpal tunnel syndrome that are not subsiding, do not hesitate to book now with one of our specialists

By Mr James Nicholl
Orthopaedic surgery

Mr James Nicholl is an expert orthopaedic surgeon based in Tunbridge Wells who specialises in hand and wrist surgery. He performs a range of trauma procedures and is most interested in the treatment of fractures of the hand and wrist.

Mr Nicholl underwent his medical training at Cambridge University and Guy’s Hospital London and graduated in 1988. He completed his orthopaedic training on the Guy’s and St Thomas’ rotation. He undertook fellowships in shoulder surgery (Guy’s Hospital) and hand surgery (Queen Victoria Hospital).

Mr Nicholl’s elective practice is almost entirely upper limb surgery, treating conditions such as carpal tunnel syndrome, Dupuytren’s contracture, hand, wrist and elbow arthritis, tennis elbow and trigger digits.

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