Is it carpal tunnel?

We all wake up sometimes with a numb and tingly hand. But ongoing hand pain and numbness can be a disabling problem that requires diagnosis and treatment.

Here are some of the main causes of hand pain and numbness, and, how you can tell them apart.

The median nerve can be irritated in the carpal tunnel at the wrist or at its origin in the cervical spine (neck).

Carpal tunnel syndrome

When hand pain is experienced, it's common to first suspect carpal tunnel syndrome. This condition is caused by the narrowing of a bony passageway in your wrist, which irritates or compresses the median nerve that runs through it. There is new evidence to suggest that manual therapy could improve the symptoms of carpal tunnel, text here:

Symptoms tend to be in the thumb, index finger, or middle finger, along the path of the median nerve. The pain may wake you up at night or be worse in the morning. In the early stages, shaking your hand may bring relief.

Cubital Tunnel Syndrome

Also called ulnar nerve compression syndrome. This condition is caused by compression (pinching) of the ulnar nerve as it passes through the cubital tunnel in the arm (elbow). This will produce numbness in the ring and little finger.

In severe cases, weakness of the hand muscles and the wrist flexors (forearm muscles that bend your wrist) on the forearm may be present. Cubital tunnel syndrome is not as common as carpal tunnel syndrome, and generally does not require surgical intervention. Numbness commonly occurs at night and is related to the position of the arm.

Sleeping with the elbow flexed will raise the pressure in the cubital tunnel three times more than normal, and sleeping with the hands behind the head will raise the pressure seven times more than normal.

Straightening out the arm will relieve the numbness, and sleeping with the arm out straight helps avoid hand numbness at night.

Rheumatoid Arthritis

Another possible cause of hand pain and numbness is rheumatoid arthritis.

Hand pain from rheumatoid arthritis tends to be different from carpal tunnel syndrome in 3 main ways:

1. It causes pain and stiffness in the large knuckles or joints of the wrist, rather than along a nerve path.

2. Its pain is symmetrical, meaning it will affect both hands simultaneously.

3. The sufferer tends to have widespread, multiple joint pain, not merely limited to the hands.

Cervical radiculopathy caused by spine conditions

While it may not seem obvious, your hand pain and/or tingling may actually be caused by a problem in your neck.

Anecdotally, I find this to be the more common reason for hand numbness and pins & needles than carpal tunnel syndrome.

The nerves that give sensation to your hands originate in your cervical spine (neck). When one or more of the 8 nerve roots that exit the cervical spine become irritated, it causes pain and other neurological symptoms down the nerve path, for example: pins and needles, numbness, reduced grip strength. This is known as cervical radiculopathy.

The most common conditions that can trigger radiculopathy include:

• Cervical herniated or degenerative disc disease

• Cervical spinal stenosis

• Joint stiffness

• Muscle over-activity

Again, anecdotally, I find the bottom two to be the most common reasons for median nerve impingement. Manual therapy in the form of joint mobilisations and deep tissue massage can alleviate symptoms. For all conditions above, surgery is usually easily avoidable as conservative management can be really effective.

Cervical radiculopathy pain can be mildly achy or sharp and stabbing. It can also cause numbness and/or pins-and-needles tingling sensations. Symptoms can affect different sections of the hand depending on what level of the spine is the source of the irritated nerve.

Since carpal tunnel syndrome and cervical radiculopathy can both affect the median nerve, it’s important to note one key difference: Carpal tunnel syndrome pain will only affect the hand and wrist, whereas cervical radiculopathy will often cause pain and symptoms along the arm, as well as in the hand.

Aside from these causes, hand pain can also be caused by a variety of other conditions, including diabetes and nutritional issues. Because I am not a dietitian, it would be prudent of me to give diet advice. I would recommend liaising with a dietitian or your GP for diet advice.

If you are suffering from any of the symptoms above and would like more advice, then contact us or follow us on Facebook for more details and advice