Carpal tunnel syndrome is a common condition with numbness in hands. However, it is not the only cause of hand numbness. Other potential causes are listed below. Show CausesCompression NeuropathyCompression neuropathy is pressure on a nerve anywhere along its course (Figure 1). In addition to numbness, compression neuropathy can cause weak or twitchy muscles. The pressure may come from many sources. It can occur after an injury due to bleeding or swelling. A displaced or angled fracture can stretch the nerve. Sometimes tendon lining thickens in an enclosed space, and nerve pressure rises. Fascia is a structure below the fat layer that covers muscles and tendons. Sometimes a thickened edge of fascia or tendon can compress a nerve. An abnormally located muscle can also cause pressure. Soft tissue masses or ganglion cysts can result in nerve compression. Types of nerve compression include: Ulnar nerve compression at the wrist (Guyon Syndrome) Ulnar nerve compression at the elbow (Cubital Tunnel Syndrome) Radial nerve compression in the forearm or wrist When the radial nerve branch is compressed, it typically is a sensory only problem. This nerve can be injured from cuts, placement of an IV for medication or fluids, handcuffs, or during surgeries on the radial bone. Median nerve compression at the wrist (Carpal Tunnel Syndrome) Median nerve compression at the
elbow Pressure on nerves in the neck (Figures 2-3) Sometimes, a nerve may suffer from pressure at more than one area. This is called “double crush.” Pressure on a nerve may require surgery to get relief. Peripheral NeuropathyIn peripheral neuropathy, the very ends of the nerves in the hands and feet are affected. With this condition, there may or may not be pain, and the numbness is often constant. Diabetes, alcoholism, and old age are common known causes of neuropathy. Poisoning from metals and industrial compounds are also possible causes. It typically shows a "stocking-glove" pattern in which the numbness moves up from the toes to the legs. At the time the numbness progresses to the mid-calf, then the fingers and hands become involved. It can happen on both sides of the body and often affects all nerves to the feet or hand in a similar amount. FibromyalgiaMillions of Americans suffer from this condition, which can last for years or indefinitely. People with fibromyalgia have been shown to be more likely than others to develop carpal tunnel syndrome and may seek surgical treatment to release pressure in the carpal tunnel. People with this condition have persistent pain, frequently in many areas throughout the body, as well as fatigue, headaches, bowel problems, depression, sleep problems and other generalized symptoms. Myofascial Pain SyndromeThis is another condition known to cause numbness in hands. It has some symptoms similar to fibromyalgia, specifically numb hands and numb forearms, often with aches and pain. Although the symptoms may be felt in the hands, the muscles causing the problems are usually those in the neck and shoulder region. The symptoms are usually stiffness and may be associated with frequent headaches. There is no hand surgery to correct or improve symptoms with this condition. MedicationsCertain medications, such as cancer treatment drugs, are known to cause tingling and numbness in hands. Some of these cause temporary numbness that goes away after completion of the chemotherapy treatment. Others may cause permanent numbness. Other CausesOther causes of numbness in hands may include:
TreatmentDiagnosisThe pattern of symptoms can help determine if the cause is pressure on a nerve, a disease, medications, or another condition. For many of these disorders, a thorough history and physical exam are most important to narrow down or make a diagnosis. Further tests such as an x-ray, an MRI, nerve tests (such as EMG), ultrasound, blood tests, or a spinal tap may be used to help confirm a diagnosis. TreatmentSpecific treatment recommendations can be made by your hand surgeon once you are diagnosed. You may also be referred to other specialists such as a neurologist, rheumatologist, pain management specialist, or other health care provider. When there is weakness or stiffness, hand therapy may be helpful. Your hand therapist will show you some strengthening exercises that can be helpful. Wrist or elbow braces can often improve positional numbness. Some of the compression neuropathies can be treated with steroid injections (also known as a cortisone shot). When other non-operative treatments have failed, surgical decompression can be considered. Symptom improvement is dependent on time of pressure, severity of pressure, and other patient factors. Some problems can be fully treated. Other times, not all numbness or weakness will go away with treatment.
Nerve injury can sometimes be permanent. If medical treatment at least stops the problem from getting worse, that can be considered a good benefit. To reduce the chances of permanent numbness, tingling, or weakness, find a hand surgeon to evaluate you early after symptoms start. © 2020 American Society for Surgery of the Hand This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you. |