Numb tingling hands, it’s probably carpal tunnel syndrome

slide2

Numbness and tingling in the hands is most often from Carpal tunnel syndrome (CTS).

CTS is caused by compression of the median nerve as it travels across the wrist with the tendons between the carpal bones and the flexor retinaculum (also know as the transverse carpal ligament):

flexor retinaculum

CTS is caused by compression of the median nerve under the flexor retinaculum also known as transverse carpal ligament.

Compression an injury to the median nerve causes numbness and tingling mostly affecting the thumb, index finger, middle  finger, and half of the ring finger.

cts_numbness

CTS usually causes numbness and tingling mostly in the thumb, index and middle fingers

More severe cases also cause weakness and wasting of the muscle at the base of the thumb that abducts the thumb away from the fingers (abductor pollicis brevis or APB):

thumb abduction

Thumb abduction, the movement that is weak in more severe cases of CTS, where there is involvement of both motor and sensory median nerve fibers.

OLYMPUS DIGITAL CAMERA

Wasting of APB muscle belly (“thenar eminence”) in severe CTS

In severe cases, the numbness can seem to affect the whole hand, and can even radiate up the forearm and arm:

Carpal-Tunnel-foream

Symptoms are often worse typing, driving, and frequently wake the affected patient up at night:

cts night

xx

CTS can usually be diagnosed on clinical grounds.  A helpful physical finding is a tingling in the wrist and fingers caused by a tap over the carpal tunnel (Tinel’s sign):
http://www.youtube.com/watch?v=VtrC9dnVrrQ&start=37&rel=0

In some cases, an electrodiagnostic study may be necessary to confirm the diagnosis:

cts emg

xx

CTS is usually “idiopathic” (we don’t know why it happened), but some cases are caused by diabetes, pregnancy, thyroid disease, joint swelling from rheumatoid arthritis, heavy manual work and work with vibrating tools.

Treatment usually begins with conservative measures, like avoiding exacerbating activities, and wearing a neutral position night splint:

cts splint

Patients who do not improve with these conservative measures can undergo a surgical procedure to release the compressed median nerve:

xx

Want to find out more?

Click here to take an on-line quiz to see if you have CTS.

Watch this on-line video tutorial explaining the causes and treatment of CTS:
http://www.youtube.com/watch?v=_p799CIpRL0&start=13&rel=0

If you think you might have CTS, you should make an appointment to see a neurologist.

Click here to use our physician finder service.

Advertisements

5 thoughts on “Numb tingling hands, it’s probably carpal tunnel syndrome

  1. I made a differential diagnosis of numbness and tingling in the fingertips (click above); there are probably more than 300 causes. Causes of carpal tunnel syndrome, besides those mentioned in the article include: various congenital disorders of the wrist, acromegaly, water retention (kidney disease), certain drugs (e.g. corticosteroids, contraceptives), lymphedema after removal of the lymph nodes from the axilla (as part of breast cancer therapy), scleroderma, amyloidosis, multiple myeloma, etc.

  2. Reblogged this on palmitoylethanolamide4pain and commented:
    Carpal Tunnel Syndrome can be treated with PEA, before one decides to operate. In a clinical trial PEA reduced CTS symptoms and pain. No side effects were observed.

    • Thanks for the comment. I agree that PEA has been shown to reduce symptoms of neuropathic pain from various causes, including diabetic neuropathy, in several small studies. I also agree in general with trying every conservative treatment before resorting to surgery. However, don’t forget that CTS is a mechanical problem, and sometimes a mechanical solution (i.e. surgery) is necessary in severe cases to prevent permanent nerve damage. If you think you might have CTS you should see a neurologist and discuss all your options.

      • Definitely! What we try to bring across, is that there are treatment options for chronic pain syndromes which are very often forgotten by mean stream, because no pharm industry reps support these, and the treatment with supplements (alpha lipoic acid, palmitoylethanolamide) is without any troublesome side effects and should therefore much more often be implemented…primum non nocere!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s