Tingling (paraesthesia). The syndrome starts slowly. At first the discomfort is characterised by tingling (paraesthesia) and numbness of the hand and with pain in the wrist and hand. These appear intermittently any mainly at night or on waking up. The tingling can waken up the person who shakes the hands to alleviate the discomfort. The pain can extend to the entire arm and even to the shoulder, but the tingling is usually only located in the hand.
Reduction in sensitivity. Later on there may be a decrease in the sensitivity of the hand, particularly in the part distal to the radial portion of the palm of the hand and the palmar side of the fingers, from the first to the third and the radial half of the fourth.
Clumsiness and weakness. As the carpal tunnel progresses and becomes of moderate grade there is clumsiness and weakness in the hand that leads to the dropping of objects from the hands. The symptoms get worse with the activity of the hand.
The sensory symptoms appear first and later the motor symptoms are gradually added. It usually affects the dominant hand more, although it is bilateral in 73% of cases, it is more severe in the dominant hand.