Hand Numbness and Tingling, by David Katz, MD
Do your hands ever go numb and tingly? Do you wake up at night with a “dead” hand and have to shake it out to get it to “wake up?” Do your hands fall asleep while driving a car or holding a cell phone? If so, then you may have increased pressure on a nerve in your palm – a condition called Carpal Tunnel Syndrome.
Carpal Tunnel Syndrome (CTS) is the most common cause of numbness and tingling in the hand. As a result of pressure on the median nerve, one may experience pain, weakness, and numbness in the hand and fingers. This typically affects some combination of the thumb, index, middle, and ring finger. The causes of carpal tunnel are varied, but most of the time there is no obvious reason. Women are more commonly affected than men, and the incidence increases with age. CTS can be associated with a number of prevalent medical conditions including: obesity, diabetes, hypothyroidism, rheumatoid arthritis, alcoholism, and drug toxicity. Pregnancy has also been associated with CTS – typically during the third trimester and may be related to fluid retention.
The diagnosis of CTS is based largely on the symptoms experienced as well as the exam performed by a physician. As mentioned above, most people relate symptoms that wake them from their sleep. Daytime activities such as holding a steering wheel or a book for an extended period of time may exacerbate the numbness and tingling as well. It is common for both hands to be involved – though one side may be more symptomatic. With longstanding compression, patients often complain of decreased grip strength and difficulty holding on to objects.
During a visit to your physician, you may be asked to perform several tests that will help determine whether or not CTS is the correct diagnosis. Your doctor will search for other possible causes of numbness and tingling including pinched nerves in the neck or elbow. They will also test the small muscles in your hand for any loss in strength (more commonly seen in chronic cases), as well as the feeling in your finger tips for any loss in sensation.
If your physician is concerned about CTS, he/she may send you for a nerve study. This test involves stimulating the median nerve and taking measurements which tell us how well the nerve is conducting its signal. The second portion of the test involves testing the electrical activity of the small muscles in the hand.
Treatment of CTS typically begins with nonsurgical options (except in longstanding cases with muscle weakness or significant loss of sensation). Most commonly this will involve wearing wrist splints at night time and intermittently during the day. Other treatment options include: anti-inflammatory medications (ibuprofen, naproxen, etc.), steroids (either oral or injections), ultrasound, and occupational therapy.
When these conservative measures fail to relieve symptoms, your physician may recommend surgery. While there are several different techniques to performing a carpal tunnel release, they all involve releasing the pressure on the nerve by cutting the ligament that sits above the nerve. This can be done with modern, minimally invasive techniques that serve to relieve symptoms (especially at night) and ease recovery.
If you have hand numbness and tingling, you may have CTS. Talk to your physician about this treatable condition.