Chronic Hand Numbness and Pain: Which Specialist Should You See?

Q: Chronic Hand Numbness and Pain: Which Specialist Should You See?

Hello： Carpal tunnel syndrome occurs when the median nerve is compressed by ligaments as it passes through the wrist, leading to numbness in the hand from the thumb to half of the ring finger. <br>Generally, sensory nerves are affected first, and after some time, motor nerves may

For years of paralysis and pain, which specialty should I consult?

Hello, doctor.
I often experience numbness, stiffness, and pain in both my hands, which has been ongoing for several years.
The pain tends to be particularly severe in winter, waking me up at night in tears, especially as I struggle to hold utensils properly.
I consulted with orthopedic and neurosurgeons, and the diagnosis was carpal tunnel syndrome, with a recommendation for surgery.
However, since I couldn't have surgery on both hands, I underwent surgery on my left hand in April 2014, which improved my symptoms.
Interestingly, my right hand suddenly stopped hurting (as I couldn't use my hands, I went to a salon for hair washing and massages).
But after six months, the pain returned in my right hand, which previously only hurt in winter, but now it hurts even in summer.
Particularly, if I perform any activity for less than five minutes, I start to feel numbness, followed by stiffness, and then pain.
After researching, I found some people suggesting that my surgery was unnecessary and that the issue might be related to my neck (the orthopedic doctor mentioned that there is compression and narrowing at the second and seventh cervical vertebrae, while the lumbar spine has issues at the second and fifth vertebrae, but the symptoms there are mild).
Therefore, I would like to ask which specialty I should consult.
What exactly is my problem? The pain is worsening, and I can't hold objects for too long.
Even my previously operated left hand occasionally feels swollen, and sometimes I experience numbness in my face.
I'm worried that if this continues, I might have a stroke.
I would appreciate your advice.
Thank you.
I am in Zhongli, Taoyuan.

Chen Xiao-Hui, 40~49 year old female. Ask Date: 2018/01/27

Dr. Jiang Junyi reply Neurology

Hello: Carpal tunnel syndrome occurs when the median nerve is compressed by ligaments as it passes through the wrist, leading to numbness in the hand from the thumb to half of the ring finger.
Generally, sensory nerves are affected first, and after some time, motor nerves may also be impacted, resulting in muscle atrophy.
If the cervical nerve roots are compressed, the area of numbness may vary.
In terms of diagnostic tests, nerve conduction studies or electromyography (EMG) are used to assess nerve response and the extent of injury.
The stroke you are concerned about is related to cerebrovascular issues, typically associated with cardiovascular risk factors such as hypertension, hyperlipidemia, and obesity.
This differs from the causes of carpal tunnel syndrome.
It is recommended that you consult a neurologist or a rehabilitation specialist for discussion, examination, and treatment.
Wishing you good health and peace.
Dr.
Tao, Neurology, cares about you.

Reply Date: 2018/01/27

More Info

Chronic hand numbness and pain can be quite debilitating, and it’s understandable that you’re seeking clarity on which specialist to consult for your ongoing symptoms. Based on your description, it seems you have already seen orthopedic and neurosurgical specialists, and you have undergone surgery for carpal tunnel syndrome on your left hand. While you experienced some improvement post-surgery, the recurrence of symptoms in both hands, particularly with the added complexity of neck issues, suggests a multifaceted problem that may require a more comprehensive approach.

Given your history and current symptoms, I would recommend consulting a physiatrist, also known as a rehabilitation physician. Physiatrists specialize in physical medicine and rehabilitation, focusing on restoring function and improving quality of life for patients with musculoskeletal and neurological conditions. They can provide a holistic assessment of your condition, considering both your hand symptoms and the potential cervical spine issues.

Your symptoms of numbness, stiffness, and pain in both hands, especially after prolonged use, could indicate several underlying issues. The fact that your symptoms worsen in winter may suggest a possible vascular component or sensitivity to cold, which can exacerbate conditions like Raynaud's phenomenon. Additionally, the mention of cervical spine involvement (specifically at the C2 and C7 vertebrae) raises the possibility of cervical radiculopathy, where nerve roots are compressed or irritated, leading to pain and numbness radiating down the arms.

A comprehensive evaluation by a physiatrist may include:
1. Detailed History and Physical Examination: This will help identify the specific nature of your symptoms and their relationship to your neck and spine.

2. Diagnostic Imaging: If not already done, MRI of the cervical spine may be warranted to assess for any herniated discs or other structural issues that could be contributing to your symptoms.

3. Electromyography (EMG) and Nerve Conduction Studies: These tests can help determine the function of the nerves and muscles in your arms and hands, providing insight into whether there is ongoing nerve compression or damage.

4. Rehabilitation Plan: Based on the findings, a tailored rehabilitation program may be developed, which could include physical therapy, occupational therapy, and possibly pain management strategies. This may also involve ergonomic assessments to ensure that your daily activities do not exacerbate your symptoms.

5. Multidisciplinary Approach: If cervical spine issues are confirmed, the physiatrist may collaborate with a neurosurgeon or orthopedic spine specialist to discuss potential interventions, which could range from conservative management to surgical options if warranted.

It’s important to address your concerns about the potential for serious complications, such as stroke. While your symptoms are concerning, they are more indicative of nerve compression or irritation rather than a direct sign of stroke. However, it is crucial to address these symptoms promptly to prevent further deterioration of your condition.

In summary, I recommend you seek an appointment with a physiatrist who can provide a comprehensive evaluation and develop a multidisciplinary treatment plan tailored to your needs. This approach will not only address your hand symptoms but also consider the potential contributions from your cervical spine, ultimately aiming to improve your function and quality of life.

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