Shoulder pain numbness in pointer finger



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.

Click here: Second Opinion Arthritis Treatment Kit




There are two clinical situations where this can occur most frequently.

The first is carpal tunnel syndrome. This presents with:

• Pain, numbness, or tingling in the hand, wrist, palm, thumb, or first three fingers
• Diffuse numbness in the forearm, upper arm, and shoulder
• Pain may wake patient up at night. Patients often describe shaking the hand or running their hand under water to obtain relief


Physical Exam:

• Tinel’s sign: tingling is reproduced by tapping anterior wrist with a reflex hammer
• Phalen’s test: tingling is reproduced by having the patients press the dorsum of his/her hands together with the wrists flexed at 90 degrees for 1 minute


Diagnostic Testing:

• Consider thyroid disease, diabetes mellitus, or inflammatory arthritis. May also occur in 2nd or 3rd trimester of a pregnancy

Treatment:

• Rest -- Avoidance of activity that induced symptoms is recommended. Ergonomic changes--assessment of the position of the computer keyboards or other work station corrections are recommended
• NSAIDs
• Splinting -- Light-weight wrist splinter, either prefabricated or custom made, designed to maintain the wrist in a neutral position for night-time use
• Corticosteroids -- If all the above measures fail, corticosteroid injection into the carpal tunnel may be useful
• Refer to occupational therapy for evaluation

• Above measures effective in 80% of cases. If still symptomatic, referral to specialist for more aggressive approaches .


Surgical Intervention:

• In the rare patients who are refractory to these measures, or who have ongoing hand weakness, surgical decompression of the carpal tunnel may be necessary
• Surgery has a good outcome in most cases, provided risk factors (such as overuse activities at work) are addressed


A more recent option may prevent the need for surgery. Ultrasound-guided percutaneous needle release of the carpal tunnel described by Malone and Wei in the Journal of Applied Research has a very good track record and should be considered. (www.arthritistreatmentcenter.com)

The other situation is a pinched nerve in the neck which causes referred pain to the shoulder as well as numbness, tingling, and pain in the rest of the arm. Depending on the level of nerve root involved, there may be numbness and tingling in the index (pointer) finger.

A patient may report neck pain or just present with arm pain. They may notice that turning their head particularly with the head extended reproduces their symptoms.

On examination they will have weakness of the muscles in the arms particularly with abduction (lifting of the arm to the side). Resisted flexion of the arm may show weakness. The biceps reflex may be abnormal.

Sensory examination in the thumb and index finger may also be abnormal.

Electrical testing with EMG will demonstrate nerve root damage at the C5-6 level. An MRI scan also will demonstrate evidence of nerve root compromise in the neck at the C 5-6 level.

Treatment will include rest, anti-inflammatory medicines, physical therapy, traction, and sometimes injections of steroid.



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