If mild carpal tunnel is like having a splinter, then severe carpal tunnel syndrome is like having a broken leg that's on fire.

There's a tremendous difference between the stages of mild and severe carpal tunnel syndrome. But the in-between or "moderate stage" is by far the most common. It lasts the longest (sometimes more than 2 years). The moderate stage is also when most patients say, "I better do something about this."

Many patients who  reach the level of severe carpal tunnel syndrome ask themselves, "How did I let this happen?" It's a common sentiment. Carpal tunnel syndrome symptoms begin very subtly. Actually, most times they go unnoticed until you find that your fingers feel clumsy or you keep dropping things. Maybe we you wake up at night with a numb or painful hand or fingers, only having it subside in the morning.

As the disorder progresses to the severe stage, symptoms will escalate from an occasional discomfort (as in the mild stage) to being constant and "punishing" (characteristic description of the severe stage). Usually this advancement occurs in less than one year. Additionally, other symptoms (like weakness and dexterity problems) very likely will appear as the disorder progresses.

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.

And if you're in the severe stage right 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.

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!"

Usually, the quality and intensity of carpal tunnel symptoms change with advancement of the disorder. Any one or more of the following may occur:

• Numbness escalates, and may include all of your fingers as well as your palm.

• Pain intensifies, and may also involve all of your fingers and your whole hand.

• Tingling can spread to all the fingers and hand.

• Burning, tenderness, and soreness may or may not intensify. That's because these sensation are often masked by the overall pain.

• Feelings of puffy or swollen feelings may intensify.

• Shooting electric shocks are more frequent, more easily triggered, and may radiate up your arm.

• Hand clumsiness and weakness will dominate how you perform tasks.

In rare cases, some of these symptoms can be felt radiating to (or beyond) the elbow. Rarer still, symptoms (usually pain) can enter your upper arm and shoulder.

Loss of hand and finger function is catastrophic in the severe stage. That's because there's severe loss of grip strength and dexterity. Patients tend to drop things like cooking pots, beverage cups, or bottles. Opening a car or house door, picking up coins, opening a jar, buttoning a shirt, hand writing, typing, or tying shoelaces is nearly impossible. Carrying anything over a few pounds will probably result in dropping it.

Not being able to use your hands normally poses significant problems with activities of daily living. Patients have great difficulty with feeding themselves, personal grooming, dressing, toileting, washing, and general hygiene.

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 (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 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 below).

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. 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 halting 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 nd nonsurgical remedies are available.

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 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 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 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. And 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 and avoidance, stretching exercises, and myofascial release massage. The results of using all of these techniques simultaneously is as good, and often better, than surgery.