Why does my hand get numb and tingly at night?

A blog about Carpal Tunnel Syndrome and Cubital Tunnel Syndrome

Insight Hand Therapy is a Hand Therapy Clinic located on the Gold Coast, providing specific assessment, treatment and active rehabilitation for hand and upper limb injuries / conditions. Telehealth hand therapy services are also offered for those who do not live on the Gold Coast or Northern NSW, or for those who are unable to attend a face-to-face appointment. The below information is intended for general information purposes and should not substitute individualised, medical or therapy advice. Please get in contact with us directly for more information or for an appointment with an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association).

We often hear clients asking a very similar question – “Why does my hand get numb and tingly at night or first thing in the morning?”

Often, people can think that this is a normal thing to experience, however it can be a sign of an underlying condition which should be investigated and treated promptly to prevent long term complications. There are several reasons why your hand may tingle of feel numb at night (or first thing in the morning), however there are two very common conditions which can cause this which will be reviewed below.

If the tingling / numbness in your hand is mostly present over the thumb, index, middle fingers and half of the ring finger (as shown in yellow) this is typical of Carpal Tunnel Syndrome.

If the tingling / numbness in your hand is mostly present in the little finger and half of the ring finger (as shown in blue), this is more typical of Cubital Tunnel Syndrome (and other ulna nerve compression conditions).

Carpal Tunnel Syndrome

This is a very common condition which occurs when the median nerve, which runs from your neck to your hand, is compressed or irritated at the level of the wrist (at the ‘carpal tunnel’). The carpal tunnel is a narrow passageway in the wrist, surrounded by bones and ligaments, which houses the median nerve and tendons responsible for bending the fingers. When this nerve is compressed or irritated, it can cause some key symptoms making it difficult to perform daily tasks.

The tingling sensation usually starts in the thumb and index fingers, but can also be present in the middle finger and half of the ring finger. Sometimes this is accompanied by a deep pain in the wrist or palm. Symptoms usually develop gradually and can include pain, numbness, tingling, weakness, and other discomforts in the hand and fingers. Carpal tunnel syndrome can occur in one, or both hands.

Causes of Carpal Tunnel Syndrome

- Repetitive hand movements: Individuals who perform highly repetitive hand movements or hold their wrist in a flexed (bent) position for prolonged periods of time are more likely to develop carpal tunnel syndrome. This includes activities such as typing, playing musical instruments, using power tools, or assembly line work.

- Trauma or injury: A wrist fracture or sprain can lead to increased fluid and swelling in and around the carpal tunnel, which can cause temporary compression of the median nerve, and symptoms.

- Poor sleeping postures: Often people can develop carpal tunnel from sleeping with their wrists bent forwards (flexed) for prolonged periods of time. In this position, the carpal tunnel actually becomes smaller which can increase pressure on the nerve which can cause symptoms.

- Medical conditions: Certain medical conditions such as diabetes, pregnancy and arthritis can increase the risk of developing carpal tunnel syndrome.

Diagnosis of Carpal Tunnel Syndrome
If you are experiencing any of the symptoms mentioned above, it is important to see an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association) for proper diagnosis and prompt treatment. If left untreated, carpal tunnel syndrome can lead to muscle wasting, especially of the muscles around the base of your thumb, which can be permanent. A hand therapy assessment will include a physical examination of the wrist, hand, and forearm, a review of your pinch and grip strength as well as an evaluation of your medical and working history. A few special tests will also be performed (such as Tinnel’s Test) which can fairly accurately indicate the presence of carpal tunnel syndrome, in addition your physical symptoms.

Your hand therapist may recommend further imaging to rule out any other pathologies, this might include an ultrasound or a nerve conduction study – but these are not always required.

Treatment Options for Carpal Tunnel Syndrome

Treatment for carpal tunnel syndrome depends on the severity of the symptoms and can range from simple lifestyle modifications to surgical interventions. Conservative treatment options are considered first-line therapy and may include the following:

- Wearing a custom-made wrist splint: A wrist splint worn at night can help keep the wrist in a neutral position and reduce pressure on the median nerve. Note there are many over-the-counter braces which are available, however many of these are not suitable to manage carpal tunnel syndrome (even if they are specially advertised for that purpose!)
- Resting the affected hand: Avoiding activities that aggravate symptoms, such as repetitive hand gripping or extended use of a keyboard or mouse
- Hand Therapy Exercises: Your hand therapist will provide specific, evidence-based exercises to facilitate nerve health, and wrist/hand strength and stability when appropriate. Do not use a stress ball at home, this can often make symptoms much worse!
- Surgery: In cases where the hand is permanently tingly / numb, or in the presence of muscle wastage (atrophy) an opinion from a Hand Surgeon is strongly recommended.

Many individuals resolve their symptoms with appropriate conservative management with hand therapy. There are many more interventions than the ones listed above that your hand therapist may recommend to best manage your carpal tunnel syndrome!

Cubital Tunnel Syndrome 

Cubital tunnel syndrome is a condition that occurs when the ulnar nerve becomes compressed or irritated at the elbow. This nerve runs along the inner side of the elbow, through a narrow passage called the cubital tunnel. This can lead to numbness, tingling, or weakness in the little and ring fingers, and the little finger side of the hand/palm.

The most common symptoms of cubital tunnel syndrome include numbness and tingling sensations in the ring and little fingers, along with weakness in the hand. Pain may be present in some cases, and may become worse when the elbow is bent for prolonged periods of time. Occasionally the inner part of the elbow can often feel tender or irritated.

Causes for Cubital Tunnel Syndrome:
Cubital tunnel syndrome can be caused by a number of factors, including repetitive bending of the elbow, leaning on your elbow for extended periods, or direct trauma to the inside of the elbow. Other factors that may contribute to the development of this condition include arthritis, bone spurs or nerve subluxation (where the nerve slides back and forth from its usual position).

Diagnosis of Cubital Tunnel Syndrome:
To diagnose cubital tunnel syndrome, your hand therapist will perform a physical examination to assess the movement of the elbow and the strength of the hand. They may also ask about any recent injuries, and other medical history. Some special tests will also be completed to assess the nerve, especially through movement.

Depending on your circumstances, your hand therapist may recommend further imaging tests like x-rays or an ultrasound to rule out other potential causes of the symptoms. Sometimes a nerve conduction study may also be recommended.

Treatment for Cubital Tunnel Syndrome
Conservative treatment of cubital tunnel syndrome is always recommended prior to consideration for surgery. Conservative treatment options include the following:

-       Rest: Your hand therapist will help you determine why you developed cubital tunnel syndrome, and recommend specific aggravating activities to avoid or alter to assist the nerve to settle down

-       Splinting / bracing: Often a soft brace worn at night to prevent the elbow from bending too far forwards can be beneficial

-       Ergonomic Modifications: Workstation modifications such as using an ergonomic mouse, adjusting the height of the desk or chair, and taking regular movement breaks can help to reduce pressure on the elbows during repetitive work activities

-       Hand Therapy Exercises: Your hand therapist will provide specific, evidence-based exercises to facilitate nerve health, and hand/elbow strength and stability when appropriate

-       Surgery: Surgery to reduce cubital tunnel syndrome is an option for advanced cases, or cases that have not responded to conservative treatment after a number of months, but this surgery is not especially common. Most individuals tend to respond well to conservative treatment measures, and often do not require surgery.

There are many more interventions than the ones listed above that your hand therapist may recommend to best manage your cubital tunnel syndrome! Cubital tunnel syndrome can be an uncomfortable and frustrating condition, but fortunately, there are numerous non-invasive treatment options available. If you are experiencing symptoms, speak with your hand therapist about what steps you can take to relieve your discomfort and improve your quality of life.

There are many reasons that your hand might go numb overnight, but carpal tunnel syndrome and cubital tunnel syndrome, as discussed above, are the most common. Remember, if you notice any of the above changes it is essential that you see an Accredited Hand Therapist (as awarded by the Australian Hand Therapy Association) for an accurate diagnosis and individualised treatment plan!