Symptoms usually start gradually and include one or all of the following: burning, tingling, pain, and numbness in the palm of the hand and the fingers, especially the thumb, index and middle fingers. The symptoms often first appear at night, during sleep. As the condition worsens the area and intensity of the symptoms may increase. So what was a mild tingling in the thumb may become pain and numbness in the thumb, wrist, and forearm. Decreased grip strength may also occur making it difficult to form a fist, grasp small objects, or perform other daily tasks. If not properly treated, true Carpal Tunnel Syndrome can cause irreversible nerve damage and permanent deterioration of muscle tissue.