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 caused by a compressed nerve.

A feeling of numbness or tingling is often caused by a pinched nerve. The term pinched nerve describes a type of damage or injury to a nerve or set of nerves. The two most common problems that cause pain and numbness in the arm and hand are carpal tunnel syndrome and a pinched nerve in the neck.

Carpal tunnel syndrome is often associated with repetitive movements with the hand, for example typing or factory line work. 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.

A rare condition, entrapment of the ulnar nerve at the wrist 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 that may be the result of direct pressure 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 over the ring and little fingers, as well as the loss of sensation at the tip of the little finger. There may be signs of muscle atrophy, or weakness of the muscles uses to spread the fingers apart. Dry, pale skin over the little finger and half of the ring finger is also suggestive of chronic nerve irritation.

You may experience a general weakening of the motor function of the hand, causing you to drop things or have difficulty opening jars. You may have a hard time coordinating your fingers while typing or playing the guitar, piano, or violin. The problem usually worsens with activities or occupations that are practiced over an extended period of time.

The 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 shoots down the arm when the neck moves; it can also cause numbness and weakness.

The hand can also be numb or tingly from a condition called thoracic outlet syndrome. Most studies suggest this involves the long, ring and small finger. These can be affected by a problem with the C7-T1 disk but a disk problem or bone spur at this level is not very common. Thoracic Outlet usually is caused by tight neck muscles called the scalenes, pressure by the collar bone itself or by a small, deep chest muscle called the pectoralis minor. Treatment may take many different approaches. Surgery is always an option but according to most authors, is needed in only two to three percent of the cases reviewed. Most problems can be worked out with a combination of treatments in about three months. If your pain or numbness keeps getting worse no matter what, after three months you may wish to try a surgical consult.

Peripheral neuropathy is a general term for disorders of the peripheral nervous system. The peripheral nervous system is the network of nerves outside the central nervous system (the brain and spinal cord) connected to the spinal cord. Peripheral neuropathy is a common condition that can cause numbness and tingling. It can be caused by diseases of the nerves or by other illnesses. Diabetes is one of the most common causes of peripheral neuropathy. Other causes may include:

• Excessive alcohol consumption
• Nutritional deficiencies
• Infection or inflammation
• Overexposure to toxic chemicals, such as mercury or lead
• Tumors
• Rheumatoid arthritis

Nerve compression problems behind the elbow are 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 tunnel has a bone passageway on both sides and the base. A ligament holds the nerve into the tunnel by crossing from one bone to the other. The ulnar nerve controls muscles used for gripping, 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. This includes most of the muscles in the hand except two muscles that lift the thumb up and out of your palm, turning the thumb into a better position for pinching. The ulnar nerve also receives feeling from the small and ring fingers from both the palm and backside of your hand.

Your complaints may result from either sensory or motor (muscle) nerve compression. For example, your 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, as when: 1) holding a telephone in the hand, 2) resting the head on the hand, 3) crossing the arms over the chest, 4) curling the arm under the body during the night.

Your hand may also become cold or numb when it is on top of a steering wheel. The other group of symptoms involves motor functions of the nerve. You may be aware that the hand has become weaker, resulting in trouble opening jars. You may drop things, or your hand may not perform quite as easily as it did before. For example, you may have difficulty coordinating your fingers while typing or playing the violin, guitar, or piano. The problems usually worsen with extended activities. Frequently there are both sensory and motor symptoms present. Often we do not know the cause of this problem.

Often, the patient experienced some injury to the region 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 contribute toward problems with pressure on this nerve. Nerve compressions are more common in people with arthritis, diabetes, thyroid problems, and those who consume a great deal of alcohol.

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.

For entrapment of the ulnar nerve at the wrist, your doctor will examine your hand and ask about your medical history, including previous or ongoing conditions of the hand, wrist, or arm. A test that is used to detect ulnar nerve entrapment at the wrist is known as Tinel’s sign, which involves testing for tingling in the ring and little fingers.

Your doctor will look for indications of muscle tissue wasting in the hand, particularly in those spaces that open when you spread your fingers. Nerve conduction studies help differentiate this condition from problems of the ulnar nerve that originate at the elbow. Your doctor will also need to rule out the possibility of carpal tunnel syndrome, ulnar artery thrombrosis in the hand, and other peripheral conditions that may result from arthritis, diabetes, alcoholism, or hypothyroidism.

Nonoperative treatment of this condition involves making changes in your routine that relieve external pressure on the ulnar nerve. This may include making an occupational change. 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. It is important to carefully manage contributing medical conditions such as diabetes and arthritis.

Surgery is required in most cases of ulnar nerve entrapment at the wrist. The surgeon uses an operating microscope (magnifying glasses) to show detail and correct the cause of nerve compression, removing a lipoma, ganglion cyst, or other small tumor. An experienced hand surgeon should perform this surgery. It can usually be done on an outpatient basis, using local anesthetic.

Patients who have constant numbness, severe weakness, or muscle wasting may have scar tissue inside the nerve. In these cases, micro-surgical release of scar tissue in the nerve is performed, again with the aid of magnifying glasses or an operating microscope.

Treatment for peripheral neuropathy often focuses on treating the condition that caused it—for example, controlling diabetes or repairing a ruptured disk. Physical therapy may also be recommended.

Pinched nerve tingling hand