Wrist Pain

Carpal tunnel syndrome is compression of the median nerve where it passes through the wrist, causing pain, numbness and tingling in the thumb, index and middle finger. It is the most common nerve entrapment in the world.^{[1, 2]}

Early on it comes and goes, and it is worse at night — the familiar version is waking up needing to shake the hand out. Diagnosis is usually clinical: the 2024 American Academy of Orthopaedic Surgeons guideline reports strong evidence that the CTS-6 clinical tool can be used instead of routinely ordering ultrasound or nerve conduction studies, so most people do not need a scan or a nerve test to get an answer.^{[3, 4]}

Everything here is about carpal tunnel syndrome, because that is where the good evidence for wrist pain sits. Other wrist problems are real and common — cartilage on the little-finger side, de Quervain’s, wrist arthritis — and nothing about them appears here. If that is what you have, ask us — we will tell you either way.

A wrist hurt in a fall is the exception, and it is the one thing on this page we would ask you to act on today. Scaphoid fractures are a common but frequently missed wrist injury; patients classically present after a fall onto an outstretched hand, with pain and tenderness in the hollow at the base of the thumb. Initial management is radiographs and immobilisation, with referral to a specialist inside seven days — and when the fracture is missed, the complications are the serious ones: the bone losing its blood supply, or a non-union that goes on to collapse the wrist.^[5]

A normal first X-ray does not settle it either. Pooling eight studies and 1,685 wrist injuries, 9.0% of the people whose scaphoid injury was suspected but whose radiographs were normal turned out to have a fracture anyway, and the reviewers found no single clinical feature that satisfactorily excludes one.^[6]

So if you hurt your wrist in a fall, do not spend any more of today on a web page. Get an X-ray before anything else

A night splint is the usual starting point. Cochrane reviewed 29 trials in 1,937 adults and found the evidence insufficient to settle whether splinting helps, with limited evidence that does not exclude small improvements. Its reviewers still draw the practical conclusion themselves: splinting is inexpensive with no plausible long-term harm, so small effects could justify using it, particularly for people who would rather not have surgery or injections. Night-only wear works as well as wearing it all day, and a neutral splint may beat an extension splint.^{[1, 7]}

Conservative treatment for carpal tunnel has a deadline, and it is the most useful thing you can know about it. The national pathway asks for no more than two conservative treatments so that surgery is not inappropriately delayed, expects mild cases to be improving inside six weeks, and refers on where symptoms are moderate, severe or getting worse, or persist past twelve weeks — because surgical results may be poorer after long periods of symptoms.^[3]

If it does come to surgery, carpal tunnel release is effective in 70% to 90% of people, depending on whether the nerve is already permanently damaged. Cochrane is more cautious than that figure sounds: surgery probably produces more clinical improvement than splinting in the longer term, probably without a clinically important difference in symptoms or hand function, and because no trial has compared it with placebo surgery or with no treatment at all, the review describes its efficacy as unclear.^{[7, 8]}