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Hand Numbness

What causes numbness, burning, and tingling in the hands?

There are multiple causes of these symptoms, but two of the most common are carpal tunnel syndrome and cubital tunnel syndrome. There are other disorders associated with these symptoms such as cervical radiculopathy (pinched nerve in the neck) or diabetic peripheral neuropathy, but often times these symptoms are caused by carpal or cubital tunnel.

What are carpal and cubital tunnel syndromes?

Carpal and cubital tunnel syndromes are caused by increased pressure on two nerves in the arm. Carpal tunnel is a confined space in the wrist. In that space there are multiple tendons and one nerve (median nerve). When the tendons are inflamed or swollen they can increase the pressure on the nerve. Cubital tunnel is pressure on the ulnar nerve (funny bone nerve) at the elbow. Again, the nerve runs in a space where there are multiple areas that can increase the pressure on the nerve resulting in symptoms.

What are the symptoms of carpal tunnel syndrome?

People will complain of pain, numbness, tingling, and burning in the hand. It often involves the thumb, index, middle, and part of the ring finger. The small finger is often spared. Patients will often say certain activities or wrist positions increase their symptoms: sleeping, driving a car, reading a book, holding a blow dryer, riding a bike or motorcycle, working in the garage, or filling out paperwork just to name a few. People often describe it differently and sometimes the symptoms can be vague. The pain is usually around the underside of the wrist and goes to the fingers with pain sometimes radiating toward the elbow. They may have weakness in some muscles in the hand and sometimes drop things.

What are symptoms of cubital tunnel syndrome?

Similar to carpal tunnel syndrome, people have pain, burning, tingling, and weakness in the arm. Patients may notice pain radiating down from the inside of the elbow shooting down the forearm. Numbness and tingling may primarily involve the small finger and a portion of the ring finger. People will also sometimes notice muscle loss and weakness. Occasionally the patient may notice they can’t straighten their small and ring fingers all the way, or that they have difficulty spreading their fingers. Often symptoms are worse at night when the elbow is bent.

Who gets carpal and cubital tunnel syndrome?

Essentially almost anyone can get these, but they are more common in women and the elderly. They can occur during pregnancy and are more common in people with metabolic disorders like diabetes and thyroid disorders. Diseases like rheumatoid and lupus or inflammatory disorders can increase chances of developing these syndromes. Certain jobs or activities that include forceful grasping or vibration (i.e. mechanics or motorcycle riders) can cause or increase symptoms. Typing may irritate symptoms but has not been shown to cause carpal tunnel syndrome.

What can you expect at your doctor’s visit?

Your doctor will take a history of symptoms, often asking similar questions as above like “When did your symptoms start?” and “What makes them worse, and when do they occur?” They will perform a physical exam, frequently tapping on individual nerves to see if they are irritated. Oftentimes they will press on the nerve to increase pressure and possibly produce symptoms. They will observe for muscle loss in the hands and test sensation to the fingers.

Testing:

There is a test called an EMG (electromyogram) that is sometimes ordered. This test can quantify carpal and cubital syndrome, establish a baseline, and confirm the diagnosis. It must be remembered though that these syndromes are truly diagnosed clinically and not by tests. X-rays may be ordered before surgery or to evaluate the bony anatomy. Typically MRI’s and ultrasounds are not ordered in the workup of carpal or cubital tunnel syndrome.

Non-surgical treatment for carpal tunnel syndrome:

  1. Initial treatment may consist of a wrist brace. The symptoms are worse when the wrist falls forward – often occurring while sleeping. So wearing a brace especially at night or during activities with wrist flexion can keep the canal more open and subsequently decrease symptoms.
  2. Oral steroids or anti-inflammatories are sometimes prescribed to decrease swelling around tendons in the carpal tunnel and to allow more room for the nerve.
  3. Cortisone injections in the carpal tunnel can deliver a direct effect of anti-swelling and can sometimes give fairly significant relief. Combined with bracing, injections can significantly reduce symptoms.

Surgical treatment of carpal tunnel syndrome:

If conservative treatments fail, your doctor will discuss surgical options. The surgery includes cutting a ligament at the wrist. There are two ways to cut this ligament – either endoscopic (with a scope) or open. Your doctor will discuss the risks and benefits of either procedure. Both have similar results. This is an outpatient surgery with variable anesthesia requirements. Often pain symptoms can resolve quickly after surgery, while decreased numbness is more variable depending on the severity of your carpal tunnel syndrome. People can often return to light work within a week and return to heavier work in 6-8 weeks.

Treatment of cubital tunnel syndrome:

  1. Non-operative treatment often consists of observation, sleeping with the arm in extension (sometimes with splinting), and/or medications such as anti-inflammatories or nerve medicines (Neurontin or Lyrica).
  2. Operative treatment includes decompression of the ulnar nerve (funny bone nerve) at the elbow. The nerve is freed from any structures that can put pressure on the nerve. Sometimes the nerve is moved so it’s in a nice free space, or they shave a portion of a bone to allow for freedom. This is an outpatient surgery done under general anesthesia. People can resume light activities in a couple of weeks with heavier activities resuming at 10-12 weeks.

Carpal and cubital tunnel syndromes are common causes of numbness, tingling, and pain in the upper extremity. These require clinical diagnosis and treatments. The treatments are very effective in giving relief to symptoms. Surgery can give lasting relief and is usually performed as a fairly quick outpatient surgery. If you have symptoms, difficulty sleeping or doing activities without shaking out or changing hands, you may have carpal or cubital tunnel syndrome. Call the Reno Orthopedic Center if you need to be evaluated.