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Common Causes of Numbness in the Hands

Many individuals experience occasional numbness in extremities due to posture and positioning while sitting or lying down. This type of numbness is typically the human body’s normal reaction to exerting weight and force on to certain nerves and areas of the body.

Ongoing, chronic, or debilitating numbness, however, is often caused by an underlying condition. The seriousness and risks associated with the numbness vary greatly depending upon the part of the body that is affected by the numbness and the underlying condition which is causing the symptom.

While numbness has been reported in nearly all parts of the human body, the hands are among the most common body parts associated with numbness, tingling, and sensations of “pins and needles”. Numerous conditions have the ability to cause numbness in the hands, though the most common include:

B12 Deficiency

Vitamin B12 plays a vital role in the overall function and health of the human body. Due to this fact, it is no surprise that a lack of B12 can cause problems such as numbness and tingling in the hands.

Individuals which do not consume Vitamin B12 through their diets (commonly those practicing vegetarian and vegan diets) are the most at risk for developing symptoms of B12 deficiency.

Peripheral Neuropathy

Commonly resulting from injury, infection, metabolic issues, hereditary conditions, and exposure to assorted toxins, peripheral neuropathy is an umbrella term for conditions affecting nerve function. These conditions often cause impairment of nerve function in the hands and feet, which may cause numbness, tingling, sensations, and weakness.

Type 2 Diabetes

Generally known as adult-onset diabetes, type 2 diabetes affects the human body’s process of metabolizing sugar, creating a resistance of the regulatory hormone known as insulin.

Among the many symptoms which type 2 diabetes is known to cause are numbness, tingling, pain, and sensations in the hands.

Alcoholism

Surprising to many, the long term effects of the abuse of alcohol are known to cause many seemingly strange conditions in the human body, such as nerve damage, which in turn has the ability to cause numbness in the hands and feet.

Carpal Tunnel Syndrome

A condition affecting hundreds of thousands of Americans each year, carpal tunnel syndrome is often associated with various hand symptoms, including numbness and tingling.

While those performing repetitive movements of the hands on a daily basis are more likely to suffer from carpal tunnel syndrome, this condition is not always necessarily caused by movements of the hands.

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Carpal Tunnel Syndrome

Do you often feel numbness or tingling in your hand, especially at night? Maybe you experience clumsiness in handling objects and sometimes you feel a pain that goes up the arm to as high as the shoulder. These may be the symptoms of carpal tunnel syndrome

The median nerve travels from the forearm into your hand through a “tunnel” in your wrist. Wrist bones form the bottom and sides of this tunnel and a strong band of connective tissue called aligament covers the top of the tunnel. This tunnel also contains nine tendons that connect muscles to bones and bend your fingers and thumb. These tendons are covered with a lubricating membrane called synovium, which may enlarge and swell under some circumstances. If the swelling is sufficient it may cause the median nerve to be pressed up against this strong ligament which may result in numbness, tingling in your hand, clumsiness or pain described above.

How is it diagnosed?

  • Numbness and tingling in the hands, especially when these symptoms occur at night and after use of the hands
  • Decreased feeling in your thumb, index, and long finger
  • The presence in your hand of an electric-like shock or tingling (like hitting your “funny bone”) when your doctor taps over the course of the median nerve at the wrist
  • The reproduction of your symptoms by holding your wrists in a bent down position for one minute

In some cases your doctor may recommend a special test called anerve conduction study. This test, done by a specialist, determines the severity of the pressure on the median nerve and may aid your orthopaedic surgeon in making a diagnosis and forming a treatment plan.

What causes it?
Anything that causes swelling, thickening or irritation of the synovial membrane around the tendons in the carpal tunnel can result in pressure on the median nerve.

Some common causes and associated conditions are:

  • Repetitive and forceful grasping with the hands
  • Repetitive bending of the wrist
  • Broken or dislocated bones in the wrist which produce swelling
  • Arthritis, especially the rheumatoid type
  • Thyroid gland imbalance
  • Sugar diabetes
  • Hormonal changes associated with menopause
  • Pregnancy

Although any of the above may be present, most cases have no known cause.

How is it treated?
Applying a brace or splint, which is usually worn at night and keeps your wrist from bending, may treat mild cases. Resting your wrist allows the swollen and inflamed synovial membranes to shrink; this relieves the pressure on the nerve. These swollen membranes may also be reduced in size by medications taken by mouth called non-steroidal anti-inflammatories. In more severe cases, your doctor may advise a cortisone injection into the carpal tunnel. This medicine spreads around the swollen synovial membranes surrounding the tendons and shrinks them, and in turn, relieves the pressure on the median nerve. The dosage of cortisone is small and when used in this manner it usually has no harmful side effects. The effectiveness of non-surgical treatment is often dependent on early diagnosis and treatment.

In those patients who do not gain relief from these non-surgical measures it ma be necessary to perform surgery. The site of the operation is made pain-free by local anesthesia injected either into the wrist and hand or higher up in the arm. The surgery itself is called a “release” – cutting the ligament that forms the roof of the carpal tunnel to relieve the pressure on the median nerve. The surgery is usually performed in an outpatient facility and you are generally not required to stay over night.

Treatments
For mild cases, a splint or brace may be adequate. The usage of a splint or brace during the night could reduce the swelling, thereby reducing the pain. There are also oral medications that reduce the size of the swollen membranes.

For more severe cases, an anti-cortisone injection into the carpal tunnel may be the best solution. If none of these methods provide relief the next step would be surgery.

Surgical technique
The site of operation would be numbed by a local anesthesia either injected into the upper arm or the wrist by your anesthesiologist. Then the surgeon “releases” the tension in your wrist by cutting the top of the carpal tunnel to relieve the pressure.

Another method has proven to have a 99% success rate. We perform a flexor tenosynovectomy with a median neurolysis. This means that the surgery includes:

  • The removal of the flexor tenosynovium, which may be inflamed to cause discomfort for the patient.
  • The removal of the crushed median nerve trunk, which causes the numbness most patients with carpal tunnel syndrome complain about.
  • Either surgery technique can be done on an outpatient basis. No overnight hospital stay is required.

After surgery
Your symptoms may be relieved immediately or in a short period of time. Recovery period is about 10 days. Tenderness at the incision site may persist until healing is complete. Numbness may remain for a period of time. It may be several weeks before you can return to your normal level of physical activities.

You will be given hand exercises to do at home to help rebuild circulation, muscle strength and joint flexibility in your hand and wrist.

Stop the pain and get your hand checked. Call +65 6471 2744 (24 Hours) or Email to: info@boneclinic.com.sg

Carpal Tunnel Syndrome

Carpal tunnel syndrome is pressure on the median nerve – the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.

Causes

The median nerve provides feeling and movement to the “thumb side” of the hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

The area in your wrist where the nerve enters the hand is called the carpal tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.

Carpal tunnel syndrome is common in people who perform repetitive motions of the hand and wrist. Typing on a computer keyboard is probably the most common cause of carpal tunnel. Other causes include:

  • Sewing
  • Driving
  • Assembly line work
  • Painting
  • Writing
  • Use of tools (especially hand tools or tools that vibrate)
  • Sports such as racquetball or handball
  • Playing some musical instruments

The condition occurs most often in people 30 to 60 years old, and is more common in women than men.

A number of medical problems are associated with carpal tunnel syndrome, including:

  • Bone fractures and arthritis of the wrist
  • Acromegaly
  • Diabetes
  • Alcoholism
  • Hypothyroidism
  • Kidney failure and dialysis
  • Menopause, premenstrual syndrome (PMS), and pregnancy
  • Infections
  • Obesity
  • Rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma

Symptoms

  • Numbness or tingling in the thumb and next two or three fingers of one or both hands
  • Numbness or tingling of the palm of the hand
  • Pain extending to the elbow
  • Pain in wrist or hand in one or both hands
  • Problems with fine finger movements (coordination) in one or both hands
  • Wasting away of the muscle under the thumb (in advanced or long-term cases)
  • Weak grip or difficulty carrying bags (a common complaint)
  • Weakness in one or both hands

Exams and Tests

During a physical examination, the doctor may find:

  • Numbness in the palm, thumb, index finger, middle finger, and thumb side of the ring finger
  • Weak hand grip
  • Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand (this is called Tinel’s sign)
  • Bending the wrist forward all the way for 60 seconds will usually result in numbness, tingling, or weakness (this is called Phalen’s test)

Tests may include:

  • Electromyography
  • Nerve conduction velocity
  • Wrist x-rays should be done to rule out other problems (such as wrist arthritis)

Treatment

You may try wearing a splint at night for several weeks. If this does not help, you may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot and cold compresses may also be recommended.

There are many changes you can make in the workplace to reduce the stress on your wrist:

  • Special devices include keyboards, different types of mouses, cushioned mouse pads, and keyboard drawers.
  • Someone should review the position you are in when performing your work activities. For example, make sure the keyboard is low enough so that your wrists aren’t bent upward while typing. Your doctor may suggest an occupational therapist.
  • You may also need to make changes in your work duties or recreational activities. Some of the jobs associated with carpal tunnel syndrome include those that involve typing and vibrating tools. Carpal tunnel syndrome has also been linked to professional musicians.

MEDICATIONS

Medications used in the treatment of carpal tunnel syndrome include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms for a period of time.

SURGERY

Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is successful most of the time, but it depends on how long the nerve compression has been occurring and its severity.

Outlook (Prognosis)

Symptoms often improve with treatment, but more than 50% of cases eventually require surgery. Surgery is often successful, but full healing can take months.

Possible Complications

If the condition is treated properly, there are usually no complications. If untreated, the nerve can be damaged, causing permanent weakness, numbness, and tingling.

When to Contact a Medical Professional

Call for an appointment with your health care provider if:

  • You have symptoms of carpal tunnel syndrome
  • Your symptoms do not respond to regular treatment, such as rest and anti-inflammatory medications, or if there seems to be a loss of muscle mass in your fingers

Prevention

Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury.

Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.

Stop the pain and get your hand checked! Call us at +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg

Diagnosis and Management of Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common cause of motor and sensory symptoms in the hand. The complications that result can lead to limitations of activities of daily living and time away from work. This article summarizes the investigation and treatment of this disorder in light of the result from recent clinical trials.

Introduction

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and one of the most important causes of lost days at work. The incidence  is 139 per 100,000 person years for men and 506 for women.

The sex ratio varies from 2:1 in the UK to over 20:1 in South Korea. It is often present in both hands. Repetitive wrist movements, high-force hand grip and the use of vibrating tools have been associated with an increased prevalence. In many countries, CTS is recognized as a compensable occupational disease.

Anatomy and Pathophysiology

The medial cord of the brachial plexus from roots C8 and T1 from the motor supply of the median nerve while sensory fibres from the lateral aspect of the hand run in the lateral cord, from roots C5, C6 and C7. The terminal branches of the median nerve supply the thenar muscles (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis) and the lateral two lumbricals. A number of anomalies are found in normal individuals at all levels of the nerve, e.g. the median and musculocutaneous nerve may be fused, the ulnar may supply all the thenar muscles and the median may supply the intrinsic muscles. These variations need to be considered during electrophysiological assessment. The floor and sides of the carpal tunnel are formed by the eight carpal bones. The tranverse carpal ligament forms the roof; it is attached to the hook of hamate and pisiform on the ulnar side and the scaphoid and trapezium on the radial side.

CTS is a sonsequence of compression of the median nerve within the carpal tunnel resulting in mechanical compression and local ischaemia. A rise in intracarpal canal pressure leads to reduced epineural blood flow and intrafascicular oedema. Histological examination of synovial biopsies shows a marked increase in fibroblast density, collagen fibre size and vascular proliferation compared with controls, changes that are similar to those seen after injury to other tissues. With time, changes in the myelin sheath and axonal injury are evident on nerve conduction testing. Over its long course, the median nerve becomes susceptible to compression at sites other than the carpal tunnel. In the pronator syndrome, the nerve is compressed by the pronator teres muscle, causing numbness in the hand and forearm tenderness. A proximal branch of the median nerve, the anterior interosseus nerve, may be compressed, producing weakness confined to the flexor pollicis longus, flexor digitorum profundus and pronator quadratus but without sensory loss.

Carpal Tunnel Syndrome

 Diagnosis

The clinical features in patients with electrophysiologically confirmed CTS are variable, but numbness over the lateral aspect of the hand is a typical feature of the syndrome, which may be more obvious during sustained grip, such as while reading a newspaper or driving. Initial symptoms may be intermittent but become more sustained as disease progresses. Awakening from sleep or symptoms upon awakening are common complaints. The majority of cases are idiopathic, but CTS is associated with conditions such as diabetes mellitus, renal dialysis, rheumatoid arthritis, thyroid dys-function, pregnancy and use of oral contraception.

Most CTS patients present with these classical symptoms but clinicians should be aware of atypical presenting feature.

A self-administered hand diagram has been devised to classify the level of centainty of the diagnosis into classic, probable, possible and unlikely; however, it was found to be unhelpful in the Asian population. Individuals with a high body mass index (BMI) of >29 are 2.5times more likely to develop CTS thatn those with a BMI <20.

Summary

For patients with CTS associated with other medical conditions such as hypothyroidism, treatment of the underlying disorder alone may resolve hand symptoms. Advise on avoiding activities that would exacerbate the disease should be given. Carpal Tunnel decompression is recommended at the outset for patients who have clinical or electrophysiological evidence of severe CTS and in those with symptoms of acute onset (e.g. post-traumatic). Splinting with or without steroid injection would be the first line treatment for patients with mild to moderate CTS, in view of the fact that a minority  would respond with first line treatment. Carpal tunnel release can be subsequently offered to those who do not respond to splinting and anti-inflammatory injection and to those who relapse. Failure to respond to carpal tunnel release is unusual; reasons include initial misdiagnosis, incomplete division of the flexor retinaculum, iatrogenic nerve branch injury and perineural fibrosis. Re-examination of the diagnosis and surgical re-exploration should be considered in these cases.