ANATOMY OVERVIEW

The spinal cord runs through your neck spine and sprouts off nerve roots at different levels of the neck spine. These nerve roots coalesce shortly thereafter to form a maze of nerves called brachial plexus. The brachial plexus is located just above and below your collarbone. Out of the brachial plexus emerge a number of nerves, including those that travel down your arm all the way into your hand. The main nerves that go into your hand are called median, ulnar and radial nerves.

The sensation in your hand, as well as the strength of your hand muscles, are supplied by these nerves. So, if there's a nerve compromise at any point between the neck and the hand, you may experience symptoms in your hand. Such nerve compromise may include pinched nerve root in the neck, nerve injury in the brachial plexus, or pinched nerve somewhere further down such as at the elbow and the wrist.

WHEN IS HAND NUMBNESS A MEDICAL EMERGENCY?

A vast majority of hand numbness cases do not require urgent medical care. There are rare exceptions, though. If a pronounced numbness develops suddenly, you may be having a stroke. This is especially the case if the hand numbness is part of a widespread numbness affecting that side of the body, or if it is accompanied by other changes such as garbled speech or an onset of generally feeling ill.

If your hand numbness is accompanied by hand/arm/leg weakness that is rapidly progressive, or if you experience changes in your ability to control bowel or bladder, your spinal cord may be getting significantly compromised. Acute onset of hand numbness after head or neck trauma may also be concerning.

In these instances, you will need to seek medical evaluation and treatment urgently.

COMMON CAUSES OF HAND NUMBNESS & TINGLING

As mentioned before, most cases of hand numbness are non-urgent conditions that can be treated electively. There are many possible causes of hand numbness and tingling. Here, we present some of the more common ones.

Carpal tunnel syndrome (CTS): CTS occurs as result of median nerve being compressed as it travels through the wrist. The numbness and tingling, and often also pain, can occur in any finger except the little finger. The discomfort can be aggravated by holding phone, driving (holding steering wheel) or typing. These symptoms are often worse at night. As CTS progresses, the symptoms become more constant, and the patient starts to develop hand weakness. For mild CTS, a trial of conservative treatments may be initiated and includes ergonomic and activity adjustments, wrist splint, wrist exercises and medication. More significant CTS may warrant a simple surgery.

Ulnar neuropathy at elbow (UNE): UNE occurs due to ulnar nerve being compressed as it travels through the elbow. There may be numbness, tingling or pain over the ring or little finger. As UNE progresses, hand weakness may develop. Conservative treatments are typically prescribed initially for UNE and may include activity modifications, elbow pad, physiotherapy, medication and injection. If conservative treatments fail, then surgery may be considered.

Pinched nerve root at neck (cervical radiculopathy): As a nerve root exits from the neck, it may be pinched if there is disc herniation or other structural changes nearby. This may present as numbness, tingling or pain in hand. The affected part of the hand depends on which level of the neck has the pinched nerve root. Because this is a neck issue, the patient may often have some neck discomfort. There may also be pain that shoots down the arm. Initial treatments are usually conservative and include physical therapy, medication, activity modifications and injection. Cervical radiculopathy with profound or progressive weakness may warrant neck spine surgery.

Polyneuropathy: Polyneuropathy is the systemic disease of nerves. There are many potential causes: diabetes, thyroid problem, medication side effects, to name a few. The nature and distribution of symptoms depend on the type of polyneuropathy. The symptoms usually affect both sides and develop very slowly, but not always. Hand numbness may be preceded by foot numbness. Although we can diagnose polyneuropathy, it is not an orthopedic issue. Once polyneuropathy is diagnosed, the next step is to refer you to the appropriate doctor who can determine and treat the underlying cause of your polyneuropathy.

DIAGNOSING THE CAUSE OF HAND NUMBNESS

It can be challenging to pinpoint the cause of hand numbness, because there are many causes of hand numbness and they can mimic each other. At Cascade Orthopaedics, we have experienced doctors who will accurately diagnose and treat your hand numbness. We have specialists in hands, spine and nerve studies, and all of them have advanced fellowship training.

While hand numbness is not an urgent matter most of the time, it is to your benefit to see us before waiting too long and letting the condition advance. For instance, treatments for CTS may not provide as much benefit if the CTS has progressed to the point where it is profoundly severe.

There are many tools to help diagnose the cause of hand numbness. The most important are the clinical history and the physical examination done by our experienced doctors. Imaging studies, such as x-rays and MRI, are usually needed if a neck issue is suspected. A nerve study (electrodiagnostic study) may be helpful in confirming and locating nerve problems. All of these evaluations are available to be done on-site at our state-of-the-art Auburn clinic. The doctor will first evaluate you thoroughly to decide what study is needed, if any, and will be happy to answer any questions you may have regarding the diagnostic and treatment plan.