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The most common cause of tingling and numbness to the thumb, index and middle finger is carpal tunnel syndrome. Carpal tunnel syndrome refers to a problem related to compression of the median nerve at the level of the wrist.

A thick ligament called the carpal ligament forms the roof of the carpal canal. The flexor tendons and the median nerve run through the carpal canal. Increased carpal canal pressure produced by thickening of the tissues in the carpal canal or by wrist movements or finger bending can increase pressure on the median nerve.

The operative technique and incision line used for surgical decompression of the carpal tunnel. Illustration from Surgery of the Peripheral Nerve by Mackinnon and Dellon, reprinted with permission of Thieme Medical Publishers, Inc.

You probably have felt the effects of nerve compression ‚ÄĒ when your foot "falls asleep" or when you hit your "funny bone." The changes in the nerve produced by compression will progress with increased force of compression and/or length of time.

The first strategy of treatment is to understand the activities and positions that cause your symptoms and then try to avoid these positions. Some doctors may prescribe vitamin B6 in addition to splinting. A cortisone injection sometimes is recommended to decrease inflammation, but even if it is successful in relieving your symptoms, the tingling/numbness likely will return within a few months.

If non-operative treatment is going to be successful in relieving symptoms, you will notice a decrease in your symptoms within four to six weeks. If you do not notice any relief, surgical release of the carpal ligament is recommended.

The operation to release the carpal tunnel and to decompress the median nerve involves an incision in the palm. The surgery is usually done on an outpatient basis with an anesthetic to numb your arm. After the incision is closed, a bulky dressing is placed on your arm to keep your wrist in a neutral position for two to three days.

Patient information on carpal tunnel syndrome