by Ronald C. Bingham, M.D. Physical Medicine & Rehabilitation
Numbness and tingling of the hands is a common complaint. Although carpal tunnel syndrome is the most common cause there are many conditions that can mimic this. The four most frequent disorders are outlined below.
Carpal tunnel syndrome (CTS):
CTS is the result of a “pinched” median nerve at the wrist and is the most common cause of hand numbness. The median nerve, branches out to the fingers like the limbs on a tree. These branches go to the skin of the fingers and some of the muscles in the hand. When this nerve is “pinched,” it can cause the fingers to become numb or tingle. It also can create weakness or pain of the hand. These symptoms are usually worse at night. This pain can radiate to the forearm and shoulder. In milder cases, a wrist splint worn at night can help. In more advanced cases, a small surgical procedure is necessary.
Ulnar Nerve Impingement:
The ulnar nerve, or the “funny bone nerve”, begins in the neck and runs all the way to the hand. When it becomes irritated at the elbow, it can cause numbness in the ring and little fin- gers, or weakness in the hand. It is uncertain how the nerve becomes irritated, but it is often associated with a hard blow to the elbow or repetitive elbow bending, such as weight lifting. Sleeping with the elbow bent or repeated pressure of the elbow on a desk or chair may also injure the nerve. If you work with your elbows on the desk, try an elbow pad. Splinting the elbow in the straight or extended position at night might also help. A splint can be fashioned from a pillow or towel and tape. If your condition is uncomfortable or seems to be progressive, see your health care provider. Sometimes a surgical procedure is required.
Pinched Nerve in the Neck (Radiculopathy):
Radiculopathy results from a herniated disc in the neck or from a bony constriction where the nerve exits the neck. A herniated disc means that some of the material between two of the bones in the neck has protruded and is pinching a nerve. Usually, patients will say that the pain begins in the back of the shoulder and radiates into the arm, forearm and hand, and often will raise their hand over their head for relief. Several types of treatment are available before surgery is considered.
Nerve Disease (Neuropathy)
A generalized disease of the nerves can cause numbness or tingling in the hands or feet. The most common causes are diabetes and hereditary conditions. Neuropathy usually affects the feet first and then the hands. The numbness usually involves the entire hand rather than only certain fingers and might extend up into the forearm. Numerous medica- tions are available that can minimize the symptoms. An EMG will allow your health care provider to determine if you are suffering from one of these conditions.