Hand and arm numbness is a common complaint . I would like to discuss the most common syndromes causing these sorts of complaints. Specifically I am talking about more chronic or long-standing problems as opposed to something with sudden onset such as we may see in a stroke.
The most common and perhaps least serious cause would be carpal tunnel syndrome. This syndrome is caused by compression of the median nerve as it travels through the wrist. This usually develops slowly over time but can also be an acute problem brought on by significant repetitive activity of the hand and wrist over a short period of time. I've seen this occur quite frequently in patients who've spent the weekend painting a room for example. This typically will produce numbness, pain or tingling in the thumb, first and second fingers of the hand. All of these symptoms may exist together. Typically symptoms will get worse at night or with use of the hand. Usually carpal tunnel syndrome will develop first in the dominant hand but frequently involves both hands as it becomes more severe. In severe cases the pain may involve the entire arm. We used to believe that carpal tunnel syndrome was entirely a result of repetitive motion. Now we know that some patients are predisposed to this based on the anatomy of the wrist.
Frequently carpal tunnel syndrome can be treated conservatively when it is mild. Wrist splints, anti-inflammatory medications and B6 and B12 supplementation can sometimes be helpful. Frequently this is all that is necessary to alleviate symptoms. If a patient has weakness in the hand or aatrophy of the muscles of the thumb, surgery is recommended. Surgical decompression of the median nerve is a highly effective treatment in the majority of patients. Cubital tunnel syndrome is a similar process however involves compression of the ulnar nerve at the elbow. Numbness and tingling in the fourth and fifth digit of the hand are typical. This nerve supplies many of the muscles of the hand and therefore hand weakness and loss of dexterity or common and tend to occur early in the disease process. Progressive loss of nerve function can happen quite quickly and therefore weakness needs to be treated as a serious problem as a nerve recovers poorly if damage gets severe before surgical intervention.
Radiculopathy or “pinched nerve” is also a fairly common cause of numbness in the hand and arm. The distribution of this numbness would depend on which nerve roots were actually involved. This is frequently caused by a bulging disc or bone spurs in the neck. The most common level involved is between the fifth and sixth cervical vertebrae. This would also produce numbness in the thumb and first two fingers of the hand. Usually radiculopathy is accompanied by pain traveling down the arm, but occasionally numbness and/or tingling may be the only symptoms. Radiculopathy generally is a more serious problem than carpal tunnel syndrome and is more prone to produce nerve damage if left untreated.
The majority of patients with radiculopathy will improve with conservative treatment such as physical therapy, anti-inflammatory medications, chiropractic treatment, acupuncture etc. Cervical epidural steroid injections can also be highly effective. For those patients who fail to respond to conservative therapy or who have significant neurologic deficits, surgical intervention is also highly effective. Because most disk problems in the cervical spine are degenerative in nature, symptoms may frequently recur even if they initially responded conservative treatment.
Cervical myelopathy is the most significant problem causing numbness in the arms or hands. This commonly results from spinal cord compression from bulging discs or bone spurs. Symptoms may be on both sides and typically are accompanied by difficulty walking, loss of balance or bladder control problems. There may not be significant pain involved. Involvement of the legs with weakness or balance problems suggested myelopathy may be present and prompt surgical attention is generally necessary.
There are many causes of numbness in the arms and hands. Frequently the symptoms of several different disorders can overlap in several different disorders may exist in the same patient. Frequently consultation with a neurologist or neurological surgeon is necessary to make the correct diagnosis
Jerrel Boyer DO
Neurological Surgeon
Chicago Back Institute
