Many people that have carpal tunnel syndrome have gradually increasing symptoms over time. The first symptoms of CTS may appear when sleeping and typically include numbness and paresthesia (a burning and tingling sensation) in the thumb, index, and middle fingers, although some patients may experience symptoms in the palm as well.[3] These symptoms appear at night because we tend to bend our wrists when we sleep, which further compresses the carpal tunnel.

Patients may note that they "drop things". It is unclear if carpal tunnel syndrome creates problems holding things, but it does increase sweating, which decreases friction between an object and the skin.

In early stages of CTS individuals often mistakenly blame the tingling and numbness on restricted blood circulation. They may also be at ease and accepting of the symptoms and believe their hands are simply “falling asleep”. In chronic cases, there may be wasting of the thenar muscles (the body of muscles which are connected to the thumb), weakness of palmar abduction of the thumb (difficulty bringing the thumb away from the hand).

Unless numbness or paresthesia are among the predominant symptoms, it is unlikely the symptoms are primarily caused by carpal tunnel syndrome. In effect, pain of any type, location, or severity with the absence of significant numbness or paresthesia is not likely to fall under this diagnosis.