Pinched nerve tingling hand
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Having a hand fall asleep is often due to a compressed nerve.
A feeling of numbness or tingling is often caused by a pinched nerve. The term pinched nerve describes injury to a nerve. The two most common problems that cause pain and numbness in the arm and hand are carpal tunnel syndrome, a pinched nerve in the neck, or ulnar nerve compression.
Carpal tunnel syndrome is often associated with repetitive movements with the hand. The most common symptoms are numbness in the first two fingers, pain at the wrist and loss of grip strength. The symptoms can also involve the whole hand and radiate up the arm, and they are usually worse with movement. Symptoms often wake a person up at night due to the positions of the hands while sleeping.
Entrapment of the ulnar nerve at the wrist is less common than carpal tunnel. It is usually the result of a space-occupying lesion such as a ganglion cyst, a lipoma, or ulnar artery aneurism. Repetitive trauma, such as operating a jackhammer, sometimes causes this condition. It can also occur as a result of using the bone of the hand as a “hammer.” Nerve compression is more common in people with arthritis, alcoholism, diabetes, and/or thyroid problems.
Pain is not usually a symptom of ulnar nerve entrapment at the wrist. Most patients report weakness and increasing numbness, symptoms on the outside edge of the hand.
Depending on the location of the problem, ulnar nerve entrapment at the wrist produces sensory and/or motor changes to the hand. The most common of these is a tingling sensation of the ring and little fingers, as well as loss of sensation at the tip of the little finger. There may be signs of muscle atrophy, or weakness of the muscles used to spread the fingers apart.
A pinched nerve in the neck is caused by the nerve being compressed as it exits the spine, usually by a herniated disc or a bony spur. The pain often radiates down the arm when the neck moves; it can also cause numbness and weakness.
The hand can also be tingly from a condition called thoracic outlet syndrome. Most studies suggest this involves the middle, ring and small finger. Thoracic outlet usually is caused by tight neck muscles called the scalenes, pressure by the clavicle or by a chest muscle called the pectoralis minor. Treatment may take many different approaches. This usually can be managed conservatively. Surgery may be required.
Ulnar nerve compression at the elbow is called cubital tunnel syndrome. The ulnar nerve passes through the cubital tunnel which is a bony passageway. When you "hit your funny bone" and have tingling in the small and ring fingers, you are hitting the ulnar nerve at the cubital tunnel.
The ulnar nerve controls muscles primarily of the little, ring, and sometimes middle fingers. It also controls muscles in the hand used for strong pinch, and other muscles that coordinate fine movements.
Symptoms may primarily involve numbness and tingling in the little and ring fingers, the side and back of the hand. These complaints occur or worsen when the elbow is bent.
The cause is often related to injury of the elbow: Examples include fractures, dislocations, direct blows, and severe twisting of the elbow. The nerve can also be injured with a sudden forceful flexion and extension of the elbow as may occur when the hands are on the wheel of a car in a rear ended automobile accident. Occupations requiring significant elbow flexion throughout the day, such as typing, computer data or assembly line work may also be cause.
Treatment for a pinched nerve usually involves resting the affected area. Pain medication may be prescribed. Occasionally corticosteroid injections are used along with splinting and physical therapy. Sometimes changes in occupational routine will be recommended. In some cases, surgery is recommended. Carpal tunnel syndrome may be managed with either closed endoscopic nerve release or open release. Cubital tunnel is managed with open release. Physical therapy and splints or collars may also be used.
A new procedure called "ultrasound-guided hydrodissection nerve release" has been used as a non-surgical treatment for peripheral nerve entrapment involving both the median nerve at the wrist as well as the ulnar nerve at the elbow. For more information contact the Arthritis Treatment Center at 301 694 5800 or go to www.arthritistreatmentcenter.com
Non-operative treatment of this condition also involves making changes that relieve external pressure on the ulnar nerve. Padding or a change in position while working at a computer keyboard can help if the problem is caused by resting the hand in such a way as to apply consistent pressure on the nerve.
Surgery is required in some cases of ulnar nerve entrapment at the wrist.
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