Carpal Tunnel Syndrome (CTS) is the most common compression neuropathy. It affects 3-6% of the adult population, more often women. If you wake up with numb hands — it's time to see a doctor.

What Happens in the Wrist?

The carpal tunnel is a narrow channel on the palm side of the wrist, formed by bones and the transverse ligament (retinaculum). Nine flexor tendons and the median nerve pass through it. When tissues swell, the nerve becomes compressed — symptoms appear.

5 Main Symptoms

  1. Nighttime numbness — tingling and numbness of fingers 1-3 that wakes you up. Shaking your hands brings temporary relief
  2. Morning stiffness — fingers feel "cotton-like" in the morning, resolves within 10-30 minutes
  3. Wrist pain — aching pain radiating into the forearm and shoulder
  4. Weak grip strength — dropping objects, difficulty buttoning a shirt, opening a lid
  5. Thenar atrophy — at advanced stages, muscles at the base of the thumb "waste away"

Risk Factors

  • Work: prolonged computer work, vibrating tools, assembly line work
  • Hormones: pregnancy, menopause, hypothyroidism, diabetes
  • Anatomy: naturally narrow carpal canal, previous wrist fractures
  • Rheumatology: Rheumatoid Arthritis, gout, amyloidosis

Diagnosis

Phalen's Test: bend your wrists for 60 seconds — numbness appearing confirms CTS. Tinel's Test: tapping over the carpal tunnel causes "shooting" sensations in the fingers.

EMG (Electromyography) — the gold standard. Measures the speed of impulse conduction along the median nerve. Slowing > 4.4 m/s — confirms diagnosis.

Wrist ultrasound — shows nerve thickening, tendon swelling, nerve cross-sectional area.

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Treatment: from splint to surgery

The method is chosen according to the severity of nerve compression shown by nerve conduction studies and how much the symptoms affect daily life.

  • A night splint keeps the wrist in a neutral position and reduces night-time numbness in many patients with mild to moderate disease.
  • A corticosteroid injection into the carpal tunnel often brings relief for several months, but symptoms may return.
  • Surgery — release of the transverse carpal ligament — is indicated with marked compression, constant numbness, or weakness and wasting of the muscles at the base of the thumb. It is done under local anaesthesia, and light work is resumed after a few weeks.
  • Regenerative injections (PRP and others) have been studied in small trials; there is no evidence that they replace surgery in severe syndrome. They can be discussed with the physician in mild to moderate cases.

When to see a doctor and outlook

If numbness occurs only at night, the outlook is usually good: a splint and load adjustment often help. If numbness has become constant, weakness has appeared or your fingers feel clumsy, do not delay investigation — long-standing compression can damage the nerve permanently. More on diagnosis and treatment on the carpal tunnel syndrome page.

Who it is not suitable for and possible risks

Contraindications

  • Active infection — at the injection site or systemic, with fever.
  • Active cancer or ongoing chemotherapy.
  • Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
  • Pregnancy and breastfeeding — the procedure is usually postponed.
  • A corticosteroid injection into the same area in recent weeks.
  • A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.

Possible risks

  • Pain and swelling at the injection site for 1–3 days.
  • Bruising where blood or fat tissue is taken.
  • Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
  • The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

  1. Catapano M et al. Effectiveness of Platelet-Rich Plasma Injections for Nonsurgical Management of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Phys Med Rehabil, 2020.
  2. Verdugo RJ et al. Surgical versus non-surgical treatment for carpal tunnel syndrome. Cochrane Database Syst Rev, 2008.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

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Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

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Frequently asked questions

Why do my fingers go numb at night?

A common cause is carpal tunnel syndrome: the median nerve is compressed in the wrist, making the thumb, index and middle fingers numb. At night the wrist is often bent, which raises pressure in the tunnel.

How is carpal tunnel syndrome confirmed?

The physician performs the Tinel and Phalen tests, and the diagnosis is confirmed with nerve conduction studies and nerve ultrasound, which also show how severe the compression is.

When is surgery needed for carpal tunnel syndrome?

For constant numbness, weakness or wasting of the muscles at the base of the thumb, or when a splint and an injection have not helped. Surgery divides the ligament over the tunnel and relieves pressure on the nerve.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.