26 September 2018
Why do I have a numb/tingling hand?
There are an awful lot of reasons for having a numb or tingling/pins and needles feeling in your hands. The nerves to your hands travel a long way from your brain and can get squeezed or compressed at multiple sites. The most common compression is something called Carpal Tunnel syndrome. This is where the nerve gets pinched in a tight tunnel at the base of your hand. Remember there are other places where the nerve can be compressed and there are also problems with the nerve itself, the spinal cord of the brain that can cause symptoms in the hand, however these are extremely rare.
What symptoms are in keeping with Carpal Tunnel syndrome?
The description I often hear from patients is pins and needles that is worse at night. It can either wake them from their sleep, or be there when they wake up. They often have to shake their hand or hang their hand out of bed to make it feel better. Certain activities can worsen symptoms. Common ones include driving or reading a book or newspaper - anything that bends the wrist and raises the hand up. It used to be that being on the telephone made it worse, but mobiles have taken over and need less bending of the wrist. Often the whole hand feels numb or tingly. However, if you pay careful attention, often the little finger actually feels normal as this is supplied by the ulna nerve - just think how it feels when you hit your funny bone.
How can you test for Carpal Tunnel syndrome?
In the vast majority of patients, careful listening to the symptoms will give you a very good idea about if they have Carpal Tunnel. Examination will also add to the accuracy of the assessment. If there is any query beyond that, the nerve test (Neurophysiology) can be helpful in addition to the history and examination. They can also help quantify how much the nerve is struggling (how severe the compression is).
What treatment options do I have?
95% of people have Carpal Tunnel with no apparent cause. The other 5% are associated with Diabetes, underactive Thyroid, broken wrists, arthritis, B12 deficiency, pregnancy and many more. It is often useful to treat any underlying problem in conjunction with the usual treatment. One can start with splints to wear at night. These help keep the wrist straight when sleeping and stops the nerve getting pinched. It is really useful in people who have only night time symptoms. Another line of treatment is an injection of steroid near the nerve, to try and increase the space for the nerve in the tunnel. Finally, (or sometimes firstly) surgery can be performed - this can be undertaken open with a two inch scar in the heel of the hand or endoscopic with a smaller incision away from the sensitive palm skin.
I’ve heard mixed reports about Carpal Tunnel surgery
There are a few reasons for this. Routinely after open surgery the scar is tender and raised for four months. Grip strength is decreased by about 10% which some people in heavy jobs do notice - the vast majority don’t. What goes immediately is the pins and needles. However, numbness can remain after surgery as this is the part of the nerve that was badly pinched and may not recover. Some people worry that the surgery has made them worse, but the nerve often has different parts pressed at different amounts. Some parts work normally, some parts tingly, some parts numb (imagine your arm when you sleep on it - when you wake it’s numb and the pins and needles gets worse as it starts to wake up). Also the surgery can give two very tender points either side of the scar. The surgery can also make any pre-existing arthritis in the thumb more symptomatic.
After Carpal Tunnel release about 10% of people will have it recur within 10 years of surgical release. All treatment options can be done again.
If you’re worried, Mr Dan Armstrong will be happy to see you at Spire Nottingham Hospital. A private consultation with Mr Dan Armstrong costs £200 if you don't have private health insurance. For more information or to book an appointment call our Bookings team on 0115 937 7735.