• Think you have carpal tunnel? Complimentary self-test

• Already have carpal tunnel? This Quiz tells you its severity

There’s a big difference between mild and severe carpal tunnel syndrome—but most people spend months or even years in the moderate stage before symptoms worsen. During that time, discomfort may come and go, often dismissed as fatigue or overuse. But without proper treatment, the condition gradually progresses.

As carpal tunnel moves from moderate to severe, symptoms change from occasional pain, tingling or numbness to a more constant and intense presence. Within six months, you may start to experience new sensations such as hand weakness, clumsiness, or even electric-shock-like pain radiating from you hand. The forearm may feel tender, and in some cases, the discomfort can extend as far as the shoulder.

At the severe stage, everyday activities become a real challenge. Grip strength fades—you may drop items like a water bottle, frying pan, or phone without realizing it. Even small tasks, like buttoning a shirt, tying shoes, or opening jars, can feel impossible. For many, routine actions such as grooming, dressing, or carrying a child bring both frustration and fear.

The good news is that recognizing where you are in this progression is the first step toward stopping it. Understanding how the stages of carpal tunnel develop can help you take the right actions now—before it advances to the severe stage.

It's important to note that the mild, moderate, and severe carpal tunnel syndrome stages have nearly identical symptoms. But the intensity of each symptom increases dramatically with increasing severity.

The most common symptoms of severe carpal tunnel syndrome include one or more of the following:

• Numbness
• Pain
• Tingling (pins & needles)
• Burning
• Puffy finger feeling
• Soreness
• Itching
• Shooting electric shocks
• Clumsiness
• Weakness
• Stiffness

Doctors and therapists usually describe your carpal tunnel as “severe stage” when 4 clinical criteria are met:

1. The intensity of symptoms is maximal, and interferes with every aspect of your life.
2. Symptoms are mostly constant.
3. There's considerable loss of function (i.e., clumsiness, loss of finger dexterity, and diminished hand strength).
4. You have reduced sensation to hot and cold temperatures.
   
   

If you are not in the severe stage yet, consider yourself lucky. You have many options available to relieve carpal tunnel symptoms right now.

And if you're in the severe stage now, there are still therapies which work very effectively. One therapy is surgery. The other is a combination of non-surgical remedies which work as well or better than surgery. These therapies are described below.

None of these therapies (surgical or non-surgical) may ever get your hands back to feeling 18 years old again. But they usually can make your daily life a hundred times better.

Certain signs tell you that carpal tunnel has progressed from the moderate stage to the severe stage. By now, most patients have decided to get help rather than ignore these symptoms. 

The main signs of severe carpal tunnel syndrome are:

• Pain, numbness or tingling are maximally intense.
• Symptoms are (nearly) constant.
• You cannot do anything with your hand normally (without having to make adjustments).
• You cannot go longer than a few minutes without being distracted by your numbness or pain.

One of the most common statements severe stage patients make to therapists and doctors is, "I want to cut my hand off!"

Just when you thought carpal tunnel couldn't get any worse, it does. After the severe stage, doctors call the terminal phase of the disorder "end stage" carpal tunnel syndrome.

The end stage means, since there was no attempt at intervention, the disorder progressed to its final, catastrophic phase. This stage is not reversible with any known therapy (surgery and non-surgical remedies have no effect). 

The flattening out of the thenar eminence (thumb muscle atrophy) is the first clue you have end stage carpal tunnel syndrome. Combined with the inability to use your thumb, and you can be sure that your median nerve is effectively dead.

Another characteristic of end stage carpal tunnel syndrome is the appearance of a "claw hand". Eventually, you fingers are in a perpetual claw position due to lack of flexor tendon function (see image above).

A dangerous result of end stage carpal tunnel syndrome is losing the ability to feel hot and cold temperatures. It's common for these patients to burn themselves while cooking at the stove (see image above). Many say they didn't know there was a problem until they smelled flesh burning.

Interestingly, with end stage carpal tunnel syndrome, many patients see their pain diminish. However, the punishing numbness remains.

The sad thing is that up until the end stage, most patients had a choice about stopping carpal tunnel in its tracks. There were a variety of treatments to choose from that would have reduced or even eliminated symptoms. Even with severe carpal tunnel syndrome, surgical and nonsurgical remedies are available (see below).

But as the median nerve is dead during the end stage, there is nothing that can be done. Most carpal tunnel doctors will refuse to perform surgery on end stage patients because of the inevitable failure of surgery.

Usually, most stages of carpal tunnel syndrome can be successfully treated. This is not true of the end stage. Moreover, the less severe the disorder, the higher the success rate of the treatment.

The most successful remedies focus on relieving pressure on the median nerve. Essentially, there are 2 such treatment methods for carpal tunnel syndrome:

• Surgical
• Non-surgical

When it comes to choosing which method is best for your severe carpal tunnel syndrome, doctors, therapists, and patients consider 3 factors:

• How intense your symptoms are: less intense symptoms should be treated non-surgically. More severe symptoms can be treated surgically or non-surgically.

• How long have you've had intense symptoms: intense symptoms less than 6 months old should be treated non-surgically. Symptoms over 6 months old can be treated surgically or non-surgically.

• Have you tried treating on your own: if you tried every (medically approved) non-surgical remedy available, then surgery is your only available option.

The generally accepted success rate of carpal tunnel release surgery is 50 - 70% of "moderate-to-severe symptoms". This is based on a number of effectiveness measurements. It is irrespective of the surgical method used.

When it comes to measuring "patient satisfaction" with carpal tunnel surgery, approximately 50% success is reported. The primary reason for surgical failure or dissatisfaction is persistent symptoms and return of symptoms by the second year.

The American Academy of Orthopedic Surgeons as well as the National Institutes of Health advise having carpal tunnel release surgery only after trying all non-surgical methods first. That's because, unlike surgery, there is no disadvantage to trying non-surgical therapies before having a hand operation.

Non-surgical remedies work in the vast majority of patients with moderate and moderate-to-severe carpal tunnel syndrome. The non-surgical remedies recommended by doctors must be performed simultaneously to obtain good results. In other words, just one remedy alone (like night bracing) will not be sufficient to eliminate symptoms of severe carpal tunnel syndrome.

Studies show that the success rate of using the non-surgical approach is at least equivalent to carpal tunnel release surgery. In most patients with moderate severity, non-surgical treatments are even better than surgery.

These 4 combined remedies consist of:

1. Night Bracing
2. Rest & Avoidance
3. Hand/Finger Stretching Exercises
4. Myofascial Release Massage

If you have severe carpal tunnel syndrome then it's likely you've gone without proper treatment for some time. Unfortunately, this is a progressive disorder. That means the more advanced your symptoms, the more difficult it is to get good remission of those symptoms. By the time you reach the severe stage, you have two options available to eliminate (or greatly reduce) symptoms. They are surgical and non-surgical remedies. Carpal tunnel release surgery (using either the endoscopic or open release techniques) has about a 50% chance of providing good results. Non-surgical remedies consist of night bracing, rest & avoidance, stretching exercises, and myofascial release massage. The result of using all of these techniques simultaneously is as good, and often better, than surgery.

• Can anything be done for the end stage of carpal tunnel?

Most surgeons will not operate at this stage because the probability of success is very low. There are patients in the end stage of carpal tunnel who have had some success with myofascial release massage by the CarpalRx.

• Does carpal tunnel always progress and worsen?

This is a progressive disorder, meaning it doesn't usually reverse without intervention. However, many patients adjust their work environment or take other more aggressive measures so that the condition does not worsen. Symptoms can plateau for years.

• I can't tell if my thumb muscles look flat and wrinkly. Should I worry?

If you have carpal tunnel symptoms, but have normal thumb muscle function then you probably don't have atrophy. (But you could still have carpal tunnel!) Normal thumb function means you have full thumb strength and you can touch your thumb tip to your pinky tip.