Reasons Your Hands Hurt at Night

Written by: Erin Pellot OMS-II

Why Do My Hands Hurt at Night?

Have you ever awakened to stiff or tingling hands in the middle of the night and wondered what brought on the uncomfortable sensation? Although there are many possible causes for hand pain, a couple are known to be associated with the unconscious wrist and elbow bending (flexion) that often occurs during sleep[7].

This article will delve briefly into a couple of these causes and your options for seeking a definitive diagnosis and treatment.

If you are experiencing pain in your hand and wrist at night, contact us at OrthoNeuro. We’ll connect you with an expert orthopedic surgeon who can give you an accurate diagnosis and a customized treatment plan for you. Call us or book an appointment online today!

What Is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is the most common cause of tingling and pain in the hands[7]. Carpal tunnel syndrome usually affects the thumb and first two digits of the hand (trigger finger, middle finger, and half the ring finger), arm and wrist pain is also a common symptom of carpal tunnel syndrome.

Carpal tunnel syndrome is caused by compression of one of the main nerves of the hand (the median nerve) at the wrist. This compression of nerves and blood vessels is linked to a ligament called the flexor retinaculum that lies over the median nerve. Overuse of the wrist causes fibers in the flexor retinaculum to thicken and contract, decreasing the space for the median nerve[1].

Carpal tunnel is made worse when the wrist is flexed or extended because these motions further decrease the space for the median nerve. Since carpal tunnel syndrome is made worse when the wrist is flexed, patients may find sleeping causes increased pain.


At an appointment, the doctor will consider carpal tunnel syndrome symptoms to see if they align with carpal tunnel syndrome. They may also bend and extend the wrist to see if this elicits symptoms. Diagnostic tools may include ultrasound, x-ray, and/or a nerve conduction study (EMG) to rule out other conditions and assess the median nerve for signs of entrapment[3].


If carpal tunnel syndrome is mild or moderate nonsurgical therapy may be suggested. Wrist splinting, NSAIDs, and corticosteroids may relieve the symptoms caused by carpal tunnel syndrome.
Surgical treatment options are reserved for carpal tunnel syndrome cases that have failed conservative treatment or have been deemed severe through diagnostic testing. Surgical treatment involves dividing the flexor retinaculum and increasing space for the median nerve. Surgery can be minimally invasive, creating a small 2-inch incision where the doctor will insert a camera to visualize and open the carpal tunnel. Following surgery, the wrist will be in a splint for 1-2 weeks[8].

What Is Osteoarthritis?

Osteoarthritis, commonly known as arthritis, is another potential cause of night-time hand pain. Osteoarthritis causes localized pain and stiffness in the joints that it affects. These symptoms are worse when the joints have not moved for a while because the tissues become cool. Therefore, osteoarthritis is often painful first thing in the morning.

Osteoarthritis of the hand usually affects the base of the thumb, joints closest to the fingertips, and middle joints of the fingers[6]. It occurs when the smooth surface or cartilage that lines the joint capsule has become worn away.

This leads to an inflammatory response that causes small bony growths to form called osteophytes. The cause of osteoarthritis is thought to be rooted in joint trauma, either suddenly or over time. This trauma leads to structural changes that narrow the joint capsule leading to progressive joint damage[3].


The doctor will consider symptoms at an appointment and see if they align with hand osteoarthritis. These may include being over 45 or localization of the pain to the joints[7]. The doctor may also examine the hands for physical signs of osteoarthritis. Diagnostic tools may also include x-rays and blood tests to rule out other conditions such as rheumatoid arthritis (another form of arthritis where you’re immune system attacks your joints) though imaging is not usually necessary[3].


Osteoarthritis cannot be cured, but effective management can lessen the symptoms of this condition and slow its progression[9]. Using nonsteroidal anti-inflammatory medications (NSAIDs), either over the counter or prescribed, can help reduce pain and stiffness of hand osteoarthritis. Increasing motion in the joint with prescribed exercises has also been found to improve symptoms in many patients[7].
What Is a Hand Specialist and When Should You See One?
A hand specialist is a physician with advanced training in the anatomical structures of the hand and their treatment. After medical school, hand specialists complete a five-year residency in orthopedic surgery, plastic surgery, or general surgery, followed by a one-year fellowship in hand surgery[4].

If your pain is waking you at night, radiating, or affecting your daily routine, it may be time to seek out the opinion of a hand specialist[8]. Hand specialists have the skills to correctly identify the cause of hand symptoms and address them in a way that will preserve dexterity over time[4].


If you are experiencing pain in your hand or finger joints and notice that the pain worsens at night, talk to one of our orthopedic surgeons at OrthoNeuro. Our doctors specialize in treating all types of conditions that cause hand pain. Call us today to schedule an appointment!


  1. Aboonq MS. Pathophysiology of carpal tunnel syndrome. Neurosciences (Riyadh). 2015 Jan;20(1):4-9. PMID: 25630774; PMCID: PMC4727604.
  2. Carpal Tunnel Release. Published 2022.
  3. Carpal tunnel syndrome – Diagnosis and treatment – Mayo Clinic. Published 2017.
  4. How to Become a Hand Surgeon. American Society for Surgery of the Hand.
  5. Milind K. Carpal tunnel syndrome: Clinical manifestations and diagnosis. Up to Date. Published January 2022. Accessed July 24, 2022.
  6. Osteoarthritis – Symptoms. Published May 4, 2018. Accessed July 24, 2022.
    Orthopedic R. “My Tingling Hands Wake Me Up at Night!” | Raleigh Orthopedic. Published June 29, 2017. Accessed July 24, 2022.
  7. Scholten RJ, Mink van der Molen A, Uitdehaag BM, Bouter LM, de Vet HC. Surgical treatment options for carpal tunnel syndrome. Cochrane Database Syst Rev. 2007 Oct 17;2007(4):CD003905. doi: 10.1002/14651858.CD003905.pub3. PMID: 17943805; PMCID: PMC6823225.
  8. Yu SP, Hunter DJ. Managing osteoarthritis. Aust Prescription. 2015 Aug;38(4):115-9. doi: 10.18773/austprescr.2015.039. Epub 2015 Aug 3. PMID: 26648637; PMCID: PMC4653978.

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