What Is the Median Nerve?
The median nerve runs from your neck, through the arm, into the hand. It controls movement of some forearm and thumb muscles and supplies feeling to part of your palm and first three fingers.
Three Common Sites of Compression
• Carpal tunnel (wrist): Causes numbness, tingling and pain—often at night—in thumb, index and middle fingers.
• Pronator tunnel (elbow/forearm): Leads to aching forearm pain, plus pins-and-needles in the palm and fingers.
• Anterior interosseous branch (deep forearm): A purely motor problem causing weakness when making an “OK” sign; sensation remains normal.
Causes and Risk Factors
• Repetitive movements—typing, tool use or heavy gripping.
• Direct pressure—tight watches, braces or leaning on elbows.
• Injuries—fracture, laceration or local inflammation.
• Anatomical variations—extra muscles or fibrous bands in the forearm.
• Underlying conditions—diabetes, rheumatoid arthritis or thyroid disorders.
How It Feels: Signs and Symptoms
Carpal Tunnel Syndrome
• Numb, tingly thumb, index and middle fingers
• Night-time waking with hand discomfort
• Weak pinch and thenar muscle wasting (in long-standing cases)
Pronator Syndrome
• Deep ache in front of the elbow or upper forearm
• Pins-and-needles in thumb, index and middle fingers and palm
• Symptoms worsen when twisting the forearm or gripping
Anterior Interosseous Palsy
• Sudden weakness making an “OK” sign—unable to touch fingertips together
• Difficulty pinching or turning a key
• No change in hand sensation
Getting the Right Diagnosis
Your clinician will:
• Take a detailed history—onset, activities that trigger symptoms
• Check your arm, wrist and hand movements and strength
• Perform simple tests—tapping over the nerve or resisted muscle actions
• Order nerve studies (EMG/NCS) or imaging only if needed to confirm the site of compression
Treatment and Management
First-Line Care for All Sites
• Rest and avoid movements that make symptoms worse
• Splints or braces to hold your wrist or elbow in a neutral position
• Pain relief—paracetamol or anti-inflammatories (e.g. ibuprofen)
• Hand therapy—nerve-gliding and gentle stretching exercises
When Surgery May Be Needed
If symptoms persist after 3–6 months of non-surgical care or a clear structural cause is found, surgery can relieve pressure by:
• Releasing the transverse carpal ligament (carpal tunnel release)
• Dividing tight bands of tissue at the pronator tunnel
• Decompressing the anterior interosseous nerve in the forearm
Rehabilitation and Recovery
• Early gentle motion to prevent stiffness
• Progressive strengthening under therapist guidance
• Regular follow-up to monitor nerve recovery and adjust therapy
Preventing Recurrence
• Use ergonomic tools and maintain good posture
• Take regular breaks from repetitive tasks
• Avoid prolonged pressure on wrists or forearms
• Continue home exercises even after symptoms improve
Patient FAQs
How long will it take to improve?
Most patients feel better within weeks of starting rest, splinting, and therapy. Full recovery may take 3–12 months, depending on severity.
Will I regain full strength and feeling?
Yes—early treatment leads to complete return of sensation in carpal tunnel syndrome and full motor recovery in isolated nerve palsies.
Can I keep working and driving?
Often yes, with adjustments: use splints, ergonomic aids and take frequent breaks to protect your arm.
Call to Action
If you have pain, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Disclaimer
This information is for general educational purposes and should not be used as a substitute for professional medical advice. Consult a healthcare professional for individual guidance on your condition and treatment options.
This page was last clinically updated in May 2025