It is rare for a digit to become completely numb in CTS such that no touch, pinprick, pain, burn etc can be felt at all but a perception of loss of sensitivity of the fingertips is common and when persistent suggests more severe nerve impairment. Whereas tingling/paraesthesiae can be thought of as an increase in sensation, this symptom refers to reduced sensation. Patients who get tingling ONLY outside this area probably do not have CTS. The anatomical distribution of the median nerve suggests that this abnormal sensation should be felt only in the thumb, index and middle fingers and the adjacent side of the ring finger but in some patients it appears to spread outside this area. In carpal tunnel syndrome the distinction between tingling and pain can sometimes become blurred, the tingling of CTS sometimes possessing a peculiarly unpleasant character. In ordinary life this sensation is mostly perceived as mildly unpleasant but distinct from 'pain'. This sensation is familiar to most people from the common experience of having a foot 'go to sleep' after sitting in an awkward posture for some time or after hitting the 'funny bone' at the elbow on a door frame. Tingling/Pins and Needles (Paraesthesiae or Acroparaesthesiae) The earliest symptoms of CTS are usually tingling / pins and needles, in some combination of the thumb, index, middle and ring fingers which most characteristically wake the patient during the night, usually at about 3:00 am but a variety of other things may be noticed by the patient or medical professional examining the hand. Symptoms and signs of carpal tunnel syndrome
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