Nerve Problems In The Hands

Today's post from verywell.com (see link below) looks at problems with your hands that may leave you confused as to what the actual problem is. Many neuropathy patients have most of their symptoms around their feet and legs and some have the same symptoms but only in the hands. Others have problems with both, so determining what the reason is behind the symptoms is often difficult for the doctor to pinpoint. It's all neuropathic in nature, in that damaged nerves are involved but if you're feeling strange sensations in your hands only, or muscle weakness, or even the feeling that your joints are involved, there may be a specific reason behind that. Occasionally, in cases of pinched nerves, or overuse of the fingers (keyboard use), the entrapment can be resolved with a minor operation but whatever the cause, it's worthwhile having an idea of what's behind it all before you go to the doctor. This article offers options for identifying hand problems and let's face it, what patient doesn't want a sort of pre-diagnosis instead of that fog of not knowing which of many reasons may lay behind the symptoms! That said, self-diagnosis is a doctor's nightmare but if you feel that your hand issues relate to a fairly obvious cause, because of the nature of your daily hand use, it will save time if you can indicate to your doctor that you have an idea what's going on. This article provides a useful start to the whole process.

Causes of Hand Weakness 
By Heidi Moawad, MD - Reviewed by a board-certified physician. Updated September 14, 2016

If your hand has been feeling weak or if you have been experiencing a sensation that your hand feels ‘heavy’, you might be worried about it and wondering if you should see a doctor. If you occasionally have trouble moving your hand, or if your hand has been gradually getting weaker, you definitely need to see your doctor soon.

But, the good news is that if you have had a nagging, persistent hand weakness, you will almost certainly find out that your hand weakness is not related to a stroke.

Your hand weakness is most likely caused by a treatable medical problem. The most common causes of hand weakness are conditions that are not a stroke, and they are usually not serious or life threatening.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is one of the most common causes of hand weakness, hand discomfort and hand pain. Carpal tunnel syndrome is caused by overuse of the hand, arm or wrist, which is often related to repetitive movements such as operating machinery, computer use or typing.

Carpal tunnel syndrome results from swelling on the inside of the wrist. The swelling compresses the nerves that travel through a tunnel of wrist bones. This results in pain, tingling, numbness, weakness and lack of coordination of the hand. The discomfort and weakness can travel up the arm if the swelling and pressure worsens.

Your doctor, nurse practitioner or physical therapist can typically diagnose carpal tunnel syndrome by listening to your explanation of your symptoms and examining your hand and arm.

Sometimes a nerve conduction study is needed to confirm the diagnosis of carpal tunnel syndrome.

Carpal tunnel syndrome is a treatable problem. Rest, ice and over-the-counter anti-inflammatory medications usually help. A wrist brace and adjustment of the wrist motion during work can prevent carpal tunnel syndrome from getting worse.


And for the most severe cases, a fairly simple surgical procedure to relieve the pressure usually takes care of the problem permanently. 

Diabetic Neuropathy

Diabetes is a treatable medical illness. One of the complications of diabetes is called diabetic neuropathy. Neuropathy is an injury of one or more nerves of the body, most often affecting the hands or feet. Neuropathy can cause weakness, a sense of heaviness, trouble coordinating the movements of the affected limb, pain, tingling or a burning sensation.

Most people who have diabetic neuropathy are aware that they have diabetes, but in some instances, diabetic neuropathy can be the first sign of diabetes.

Your doctor can detect diabetic neuropathy based on your description of your complaints and a physical examination. Often, a nerve conduction study is needed to define the severity and the type of neuropathy. Blood tests can identify whether you have diabetes. Next steps include diabetes management, which can help your symptoms of diabetic neuropathy if they have not been present for too long.

Neuropathy

While diabetes is the most common cause of neuropathy, there are a number of causes of neuropathy besides diabetes, and they all can cause hand weakness. Your doctor may need to order some blood tests to determine whether you have neuropathy related to an inflammatory illness, an autoimmune condition, a metabolic problem, a nutritional deficiency or a medication side effect.

Most of the time, neuropathy causes numbness, pain or weakness of the hands and feet, regardless of the cause. Most neuropathies can improve if the cause is diagnosed and medically treated.

Arthritis

Arthritis causes pain and swelling of the joints. This can result in a sensation of weakness and trouble with movement, particularly in the hands. If you have arthritis, you might have ignored the milder, early symptoms. But arthritis can worsen over time, and for many people with arthritis, it is difficult to continue to ignore it, especially when it starts to cause weakness.

Your doctor can diagnose arthritis based on your account of hand weakness, your physical examination, and possibly blood tests and X-rays. Arthritis is a treatable condition that is bothersome, but it is not life-threatening.

Pinched Nerve - Radiculopathy

Most people have a pinched nerve at some point in life. The medical term for a pinched nerve is radiculopathy. As a nerve enters or exits the spine (backbone) it may be 'pinched' and squeezed by swelling around the spine or by pressure from the bone or joints. This typically results in pain or weakness of the arm or leg.

A pinched nerve in the neck (which is at the level of the cervical spine) may cause hand weakness because the cervical spine controls the hand. Sometimes, a pinched nerve in the neck also causes neck pain.

Your doctor or physical therapist can tell if you have a pinched nerve based on your physical examination. Usually, nerve conduction studies or imaging tests such as cervical spine CT scan or cervical spine MRI are needed to definitively identify the area and the extent of the pinched nerve.

Some people who have a pinched nerve are fortunate enough to have full improvement without any therapy or medication. A pinched nerve during pregnancy, for example, often resolves on its own without any intervention. Usually, management of a pinched nerve requires physical therapy, which is typically very effective. Sometimes, however, anti-inflammatory injections or injections with pain medications are needed. In persistent situations, surgery may be necessary. 

Herniated Disc

A herniated disc is a displacement of the cartilage that supports and anchors the spine. A herniated disc may press on the spine or on the nerves. Your spine and your nerves control the sensation and movement of your body. So a herniated disc in the upper part of the spine can produce pain and/or weakness of the muscles of the hand or arm.

A herniated disc is a condition that your doctor can diagnose based on your history of symptoms and your physical examination. An imaging test such as a spine X-ray, a spine CT scan or spine MRI is usually necessary to visualize how severe the problem is.

A herniated disc can be treated with physical therapy, anti-inflammatory medication, or pain medication. A herniated disc can be a persistent problem, causing nagging pain or weakness.

Surgery may be needed in some situations. However, in many situations of persistent pain and weakness resulting from a herniated disc, surgery might not repair the problem. Thus, surgery is not always the right option for herniated disc.

If you have a herniated disc, it is usually recommended to take extra care when doing physical activities, especially when it comes to lifting heavy objects. 

Saturday Night Palsy – Radial Nerve Palsy

Saturday night palsy is a specific kind of nerve compression that happens after one of the nerves in the upper part of the arm, the radial nerve, is compressed, usually from sleeping in a position that presses on the nerve for hours.

It is stereotypically associated with falling asleep in a slumped over position after having had too much to drink, hence the term ‘Saturday night palsy.’ However, any cause of sleeping in a position that places too much pressure on the radial nerve for an extended period of time can cause the same problem of hand weakness.

The condition typically resolves, but sometimes it is associated with serious trauma to the arm, requiring medical or surgical treatment. If you do wake up with sudden hand weakness, especially if you have consumed alcohol the night before, it is vital to get medical attention immediately because you could have suffered a traumatic injury that requires immediate medical attention.

Ulnar Neuropathy

Ulnar neuropathy is damage to a nerve called the ulnar nerve. This nerve is located near the elbow and controls arm and hand movement. Mild compression of the ulnar nerve is caused by leaning on the arm, which produces a tingling sensation often referred to as bumping the 'funny bone.'

Damage to the ulnar nerve from traumatic injury, arthritis or compression causes hand and arm weakness and tingling or loss of sensation, particularly affecting the ring finger.
What You Should Do If You Have Hand Weakness

While a stroke can cause hand weakness, there are a number of causes of hand weakness that are more common than stroke and less serious than stroke. Hand and arm tingling, similarly, can be triggered by a number of different causes. If you experience sudden weakness, you need to get emergency medical attention by calling 911.

However, if you have had gradually worsening weakness accompanied by pain, you are not having a stroke. Nevertheless, it is important to make an appointment to see your doctor if you have been having gradual hand weakness because most of these common problems can be more effectively treated if they are diagnosed and medically managed early.

Sources:

Devitt BM, Baker JF, Ahmed M, Menzies D, Synnott KA, Saturday night palsy or Sunday morning hangover? A case report of alcohol-induced Crush Syndrome, Archives of Orthopedic and Trauma Surgery, 2011 Jan;131(1):39-43. doi: 10.1007/s00402-010-1098-z.

Zyluk A, Puchalski P, Hand disorders associated with diabetes: a review, Acta Orthopedia Beligica, 2015 Jun;81(2):191-6.

 https://www.verywell.com/a-look-at-carpal-tunnel-syndrome-2564578