Every person describes carpal tunnel pain differently. That's because "pain" means something different to different people. 

Whichever way we describe it, hand or finger pain is a well-known symptom of carpal tunnel syndrome. And so is numbness, tingling, and weakness which usually accompanies the pain. In fact, these are the three most common patient complaints about carpal tunnel syndrome. 



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Today, we know a great deal about carpal tunnel syndrome (sometimes just called "carpal tunnel"). And we know a lot about what causes the various symptoms of carpal tunnel.

Pain, numbness, tingling and other abnormal sensations are the result of nerve damage. At it's core, a damaged nerve inside the wrist joint causes all of these symptoms. 

Carpal tunnel syndrome is a painful and progressive nerve disorder. Doctors technically call it a compressive neuropathy. That means the median nerve (inside your wrist joint) is damaged.

The damaged occurs because nearby tendons inside the wrist joint inflame and push on the median nerve. Nobody is sure why the tendons swell to begin with. But the result is that they swell more and more. Eventually they compress or crush the nerve.

It's thought the reason tendons swell might be due to repetitive and forceful use of your hands and fingers. That's why, for instance, typists, hair stylists, carpenters, transcriptionists, auto mechanics, guitar players, and assembly line workers (just to name a few) are infamous for getting carpal tunnel syndrome. Actually, anybody with an occupation that requires rapid and repetitive hand activity is at high risk.

For most people, carpal tunnel syndrome  begins almost without notice. Maybe you feel some tingling at your fingertips when typing. Or if you tap your hand or wrist it tingles or causes a bit of pain in the fingers. 

But as it advances, carpal tunnel syndrome becomes more and more unpleasant. Numbness and tingling usually get more intense. And if pain was only slight before, it gets much worse in a matter of weeks. That’s when life becomes truly miserable.

The remainder of this article is devoted to describing the 4 stages of carpal tunnel syndrome. Briefly, they are:

• Mild: This is just after symptoms become noticeable. They are worse when you're relaxing or sleeping. Carpal tunnel pain or numbness keep you up at night. During the day, you may notice dropping things a lot. Your hands feel clumsy.

• Moderate: Symptoms start to bother you during the day. They're more intense, and other symptoms also begin. You might feel shooting or radiating carpal tunnel pain. Tingling and numbness intensify. You lose more hand strength and dexterity.

• Severe: This is when symptoms are maximally intense. They are so bad they interfere with every aspect of your life. Pain, numbness, and tingling are almost unbearable. Hand weakness and dexterity loss is accompanied by loss of sensitivity to hot or cold.

• End-stage: In this stage, much of your median nerve has died. It results in catastrophic loss loss of hand function. But carpal tunnel pain decreases (due to the dead nerve). Numbness or tingling usually remain.

The 4 stages (and associated symptoms) of carpal tunnel’s progression vary from person to person. For example, some people advance to the severe stage in just a few months. But others might take several years. However, this neurological condition is progressive, and without intervention it will only worsen.

The stages of carpal tunnel can vary by the timing and intensity of symptoms. But they usually follow this 4 stage pattern of progression.

In the mild stage of carpal tunnel, pain, numbness or tingling definitely begin to make a showing. These sensations are usually more pronounced in the thumb, index and middle fingers. However, the little finger doesn’t show signs whatsoever. 

Pain is often accompanied by your fingers feeling puffy, even though they’re not. In over 80% of patients, these sensations occur in both hands within a 6 month period (called bilateral carpal tunnel syndrome).

The carpal tunnel pain will usually have one or more of the following qualities during the mild stage:

• Burning or itching
• Deep, dull, aching or throbbing
• Sharp, stinging or stabbing
• Shooting or electrical

In this mild stage, the finger or hand pain is usually intermittent. It's rarer for pain to be constant in the mild stage.

Also in the mild stage, the level of carpal tunnel pain is usually described as "annoying". It's rarer to describe the pain as "intense".

Usually pain advances from barely noticeable to intense within 6 months. This is when it reaches the moderate stage.

Another characteristic of mild stage carpal tunnel pain or numbness is it usually happens while you try to sleep at night. In fact, one of the hallmark symptoms of mild carpal tunnel syndrome is that you have to wake up to "rub out" the pain or "shake out" the numbness. 

Many patients first notice pain or numbness when driving their car. Holding the steering wheel causes pain, numbness or tingling in the palm or fingertips. Likewise, holding a phone up to the ear causes similar symptoms to appear.

As mild symptoms progress, patients begin to notice dexterity problems. Hands feel clumsy grasping a drinking glass, grooming, tying a shoelace, buttoning a shirt or picking up coins or keys. You begin to drop things.

Carpal tunnel syndrome weakens your hand. In the mild stage you first begin to notice a loss of grip strength but it's not a huge problem yet. But as the condition worsens without treatment, loss of hand strength will be one of your biggest problems.

In the moderate stage of carpal tunnel, pain will usually advance if it's not treated. In the moderate stage, the painful feelings will be present most of the day, not just when trying to sleep. You even have pain when your hand is resting during the day. 

Usually, at this point most people realize they have a big problem. Many begin to wear a wrist brace at night. Unfortunately, most people use the  wrong type of carpal tunnel brace. And it ends up doing more harm than good.

During the moderate stage of carpal tunnel, pain may spread to all of the fingers (but not the pinky finger). It may also spread into the palm of the hand. Sometimes pain radiates to the wrist and forearm. This pain usually starts off intermittently, and then becomes constant.

In the moderate stage, as carpal tunnel pain becomes more constant, other problems also worsen. If grip strength and dexterity was a problem before, it's very significant now. The hand feels clumsy or awkward almost all the time. That results in constantly dropping dishes or cups. Sometimes the loss of tactile feelings and strength cause your phone to flop out of your hand. Writing with a pen is very difficult.

Doctors characterize the severe stage of carpal tunnel syndrome when a patient's quality of life has significantly deteriorated. Basically, their carpal tunnel pain or numbness affects every aspect of their waking and sleeping hours. There simply is no getting away from the relentless discomfort.

In the severe stage of carpal tunnel, pain is very intense. Descriptions of the pain are often said to be crushing, punishing, fearful or brutal. Many patients say their hand feels like it's being crushed in a vice. And a majority of patients tell doctors:

"I feel like I want to cut my hand off."

In the severe stage of carpal tunnel, other symptoms also intensify and become relentless. For instance, many patients lose the ability to sense hot or cold on their skin. That means there's no detecting boiling at your fingertips. Obviously, this is potentially hazardous. And it's the reason many severe stage carpal tunnel patients scald themselves in the kitchen. In fact, patients have said they noticed their fingertips burning on a stove only when they smelled it.

Hand and finger dexterity is almost completely lost in the severe stage. The excruciating pain makes just about any movement a major ordeal. Just toileting or grooming is nearly impossible without it driving you mad. 

Severe stage patients find they have to force themselves to perform simple activities. And even then, the process is difficult at best. At this point, it's common for patients call upon someone else to prepare food, turn door knobs, make a bed or tend to small children.

The final stage of carpal tunnel syndrome is called the end-stage. Usually, its most noticeable feature is atrophy, or wasting in the muscles at the base of the thumb. 

That means the normally thick and plump muscle elevation (thenar eminence) at your thumb's base is now flat. There may still be some thumb function and feeling left over. But thumb strength and movement is drastically compromised. Most patients at this stage cannot even touch their thumb to their pinky.

Ironically in the end-stage of carpal tunnel, pain will usually diminish. But that's not a positive outcome. It means the nerve fibers to your hand and fingers have essentially died. There is no restoring feeling or function whatsoever at this point. 

Some people take about a year to reach the end-stage. Others might take several years. This time frame is completely unpredictable. 

Carpal tunnel pain, numbness, and other symptoms creep up on you slowly. By the time you notice them and try to do something about it, they usually have already progressed to the moderate stage. Without treatment, symptoms will only intensify. But the earlier you treat, the better your chances of eliminating symptoms and fully restoring your hand.