Many people have had such an experience: while sleeping soundly in the middle of the night, they are suddenly awakened by a numbness and tingling sensation in their hands. The thumb, index finger, and middle finger feel numb like they have been electrified, and it takes a long time to alleviate the discomfort by shaking or massaging.
Wang Kuai-sheng, director of the Orthopedics Department at Hainan Chengmei Hospital, reminds that the frequent numbness of the hands at night may be caused by carpal tunnel syndrome, and it should not be ignored as a trivial matter of "arm pressure".
01
What is carpal tunnel syndrome?
王快胜主任介绍，腕管综合征俗称 “鼠标手”，是临床最常见的周围神经卡压性疾病。我们的手腕掌侧，由腕骨和腕横韧带构成一个狭窄、密闭的骨纤维管道，医学上称为 “腕管”。
According to Director Wang Kuai-sheng, carpal tunnel syndrome, commonly known as "mouse hand", is the most common clinical peripheral nerve compression disease. On the palmar side of our wrist, a narrow and enclosed bone-fiber tube is formed by the carpal bones and the transverse carpal ligament, which is medically known as the "carpal tunnel".
这个“隧道”空间有限，却挤着正中神经和 9 根手指屈肌腱。正中神经负责拇指、食指、中指及无名指桡侧半的感觉与运动功能。当各种原因导致腕管内压力增高，就会压迫正中神经，引发麻木、疼痛、无力等一系列症状，这就是腕管综合征。
This "tunnel" space is limited, yet it is packed with the median nerve and nine flexor tendons of the fingers. The median nerve is responsible for the sensory and motor functions of the radial half of the thumb, index finger, middle finger, and ring finger. When the pressure inside the carpal tunnel increases due to various reasons, it will compress the median nerve, causing a series of symptoms such as numbness, pain, and weakness. This is known as carpal tunnel syndrome.
02
Why do I always wake up in the middle of the night?
"Why is it that I feel fine during the day, but my hands become numb at midnight?" This is the most common question asked by patients. Director Wang Kuai-sheng stated that the exacerbation of symptoms at night is a typical feature of carpal tunnel syndrome, which can be attributed to two main reasons:
Carpal tunnel pressure increases abruptly at night
During nighttime sleep, the wrist often involuntarily adopts a flexed or hyperextended posture, directly compressing the volume of the carpal tunnel. Simultaneously, with reduced limb movement and slowed blood circulation, inflammatory exudate from the tendon synovium tends to accumulate and cause edema, further occupying space and exacerbating the already narrow carpal tunnel, leading to more severe nerve compression.
Neural sensitivity increases at night
During the day, attention is scattered, and mild numbness is easily overlooked; at night, the environment is quiet, and the excitability of the sympathetic nervous system decreases. The human body's perception threshold for pain and numbness drops, and mild nerve compression can be amplified, resulting in a strong sense of discomfort known as "waking up in the middle of the night due to numbness".
03
Early recognition of typical symptoms
Director Wang Kuai-sheng emphasized that the symptoms of carpal tunnel syndrome have distinct stages, with early intervention yielding the best results. Delays may lead to permanent nerve damage:
Early stage (signal phase): numbness and tingling in the thumb, index finger, and middle finger, which are most severe at night or in the early morning. Activating the wrist and swinging the hands can provide temporary relief. It is often mistaken for "cold" or "fatigue".
Intermediate stage (aggravated stage): Frequent episodes of numbness, weakness of the hands, and unsteady grasping (such as inability to hold chopsticks or button up), with pain radiating to the forearm.
Late stage (deterioration stage): Atrophy of the thenar muscles in the palm (the base of the palm becomes shriveled), loss of thumb opposition function, severe restriction of fine motor skills in the hand, and by this time, irreversible nerve damage has often occurred.
04
High-risk groups should be vigilant
Director Wang Kuai-sheng pointed out that the following groups are at high risk of developing carpal tunnel syndrome. Especially in the humid and hot climate of Hainan, joint and soft tissue edema are easily induced, necessitating enhanced protection:
People who engage in long-term repetitive wrist movements: programmers, chefs, delivery personnel, mothers who frequently hold their babies, and musicians.
Women in special physiological stages: The incidence rate among women aged 30-50 is five times higher than that of men. Hormonal changes during pregnancy, lactation, and menopause can easily lead to edema and compression.
Patients with chronic diseases: patients with diabetes, rheumatoid arthritis, and hypothyroidism.
Middle-aged and elderly people: Joint degeneration, ligament thickening, and osteophytosis lead to natural narrowing of the carpal tunnel.
05
Conservative + minimally invasive, bid farewell to the trouble of "night paralysis"
(1) Early prevention: The three-step wrist care routine
Correct posture: When using a computer, keep your wrists naturally straight and in a neutral position, use a wrist rest, and avoid hanging your wrists; when doing household chores or laborious work, avoid excessive bending of your wrists for a long time.
Regular relaxation: Every 30-60 minutes, take a break and perform actions such as clenching and stretching your fists, rotating your wrists, to mobilize your tendons and relieve stress.
Keep warm and reduce swelling: Although Hainan is warm, it is still necessary to keep the wrists warm in air-conditioned rooms and at night to reduce synovial edema.
(2) Conservative treatment first, then minimally invasive surgery
Conservative treatment: suitable for early mild symptoms. It includes wearing a wrist brace for fixation, local heat therapy, oral administration of anti-inflammatory and analgesic drugs, and block therapy when necessary.
Minimally invasive surgery: When conservative treatment fails, symptoms worsen, or muscle atrophy occurs, surgical decompression is necessary. Director Wang Kuai-sheng's team employs minimally invasive carpal tunnel release, which involves making a small incision of only 1-2 cm to cut through the thickened transverse carpal ligament, completely relieving nerve compression. This procedure is minimally invasive, with rapid recovery and low recurrence rate.
Expert reminder
Director Wang Kuai-sheng reminds us that occasional hand numbness may be due to posture issues. However, if you frequently wake up in the middle of the night due to numbness, the numbness persists for more than a month, or you experience hand weakness and muscle atrophy, it is essential to seek medical examination at a reputable hospital's orthopedic or hand surgery department as soon as possible. Early diagnosis and treatment of carpal tunnel syndrome can lead to complete recovery for most patients, preventing hand disability and impacting on quality of life due to delay.
Expert Introduction
Wang KuaiSheng, Chief Physician
Director of Orthopedics
High-level talents in Hainan Province
Medical expertise
Skilled in the diagnosis and treatment of orthopedic-related diseases such as hand injuries, congenital hand deformities, nerve injuries, vascular injuries, tendon injuries, wrist diseases, peripheral nerve diseases, osteoarthritis, and lumbar diseases; possesses extensive clinical experience in the diagnosis and treatment of trauma diseases such as limb trauma and limb fractures. With microsurgical techniques, proficient in performing microsurgical-related orthopedic microsurgical repair surgeries such as nerve, vascular, and tendon injury repair, skin flap repair, and scar plastic surgery.